Healthcare Provider Details

I. General information

NPI: 1083178461
Provider Name (Legal Business Name): VIRGINIA COUGHLIN WEILL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR UNIT 121
SCARBOROUGH ME
04074-7172
US

IV. Provider business mailing address

190 RIVERSIDE ST UNIT 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7760
  • Fax: 207-396-8500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP2774
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: