Healthcare Provider Details

I. General information

NPI: 1710360235
Provider Name (Legal Business Name): ANNE PRATT GIROUX AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SILVER ST
WATERVILLE ME
04901-5927
US

IV. Provider business mailing address

124 SILVER ST
WATERVILLE ME
04901-5927
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-0320
  • Fax:
Mailing address:
  • Phone: 207-872-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAP 34
License Number StateME

VIII. Authorized Official

Name: ANNE GIROUX
Title or Position: OWNER
Credential: AUD
Phone: 207-872-0320