Healthcare Provider Details

I. General information

NPI: 1831103456
Provider Name (Legal Business Name): CONSTANCE S UPTON MSCCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 BURNT MILL RD
WELLS ME
04090-5924
US

IV. Provider business mailing address

884 BURNT MILL RD
WELLS ME
04090-5924
US

V. Phone/Fax

Practice location:
  • Phone: 207-415-6817
  • Fax:
Mailing address:
  • Phone: 207-415-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1585
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: