Healthcare Provider Details

I. General information

NPI: 1881320257
Provider Name (Legal Business Name): COLLEEN LUCY WHITTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN LUCY SLP

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WINDHAM CENTER RD
WINDHAM ME
04062-4862
US

IV. Provider business mailing address

223 W SIDE DR
VERONA ISLAND ME
04416-3417
US

V. Phone/Fax

Practice location:
  • Phone: 207-892-1800
  • Fax:
Mailing address:
  • Phone: 207-735-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST3733
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: