Healthcare Provider Details

I. General information

NPI: 1720221385
Provider Name (Legal Business Name): JENNIFER A LAPLANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDGEMONT DR
PRESQUE ISLE ME
04769-2036
US

IV. Provider business mailing address

1 EDGEMONT DR
PRESQUE ISLE ME
04769-2036
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-3319
  • Fax: 207-768-5377
Mailing address:
  • Phone: 207-764-3319
  • Fax: 207-768-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier431767599
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: