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General NPI Number Information
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NPI Number | 1174757991
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Entity Type | Organization
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Legal Business Name | FAGAN CENTER FOR COMMUNICATON LLC
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 985 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-3303
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Country | US
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Telephone | 207-797-2351
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Fax | 207-839-2197
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Provider Business Mailing Address
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Address Line | 985 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-3303
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Country | US
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Telephone | 207-797-2351
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Fax | 207-839-2197
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SUSAN MCKINLEY
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Credential | BS
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Telephone | 207-939-7072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP886
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License Number State | ME
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