MEDICARE: MRS. VALERIE DENISE GALLAGHER M.S. CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AP499	ME

General Provider Information

NPI Number	:	1073615290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE DENISE GALLAGHER M.S. CCC-A

Provider Business Mailing Address
First Line	:	149 NORTH ST
Second Line	:
City	:	WATERVILLE
State	:	ME
Zip	:	04901-4974
Country	:	US
Telephone Number	:	207-872-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SHUMAN AVE
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6020
Country	:	US
Telephone Number	:	207-622-8680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	09/03/2015

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