=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043844079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAREYN PRINCE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2020
-----------------------------------------------------
Last Update Date | 11/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 357 TUTTLE RD
-----------------------------------------------------
City | CUMBERLAND CENTER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04021-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-829-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 LITTLE RIVER DR
-----------------------------------------------------
City | GORHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04038-2553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | ST3066
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------