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General NPI Number Information
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NPI Number | 1932612371
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Entity Type | Organization
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Legal Business Name | SKILLBUILDERS SPEECH THERAPY, P.A.
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 68 BISHOP ST STE 1
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City | PORTLAND
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State | ME
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Zip | 04103-2681
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Country | US
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Telephone | 207-317-5600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11605
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City | PORTLAND
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State | ME
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Zip | 04104-7605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETH-ANNE KANECKE
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Credential | CCC-SLP
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Telephone | 207-317-5600
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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 |
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License Number State |
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