MEDICARE: MAEVE CORISH

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	235Z00000X	Speech-Language Pathologist	ST3003	ME

General Provider Information

NPI Number	:	1184275919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEVE CORISH

Provider Business Mailing Address
First Line	:	50 ADAMS ST APT 1
Second Line	:
City	:	BIDDEFORD
State	:	ME
Zip	:	04005-2995
Country	:	US
Telephone Number	:	267-530-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 SOKOKIS TRL
Second Line	:
City	:	EAST WATERBORO
State	:	ME
Zip	:	04030-5411
Country	:	US
Telephone Number	:	267-530-0830
Fax Number	:

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

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

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Directions to “ MAEVE CORISH ” Practice Location

Language	Start Address	Practice Location

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