MEDICARE: MS. ELIZABETH NORTHINGTON KALIL MA CCC SLP

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	SP1194	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	027862	OTHER	ME	ANTHEM BCBS

General Provider Information

NPI Number	:	1255477139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH NORTHINGTON KALIL MA CCC SLP

Provider Business Mailing Address
First Line	:	19 EASTLAWN RD
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1912
Country	:	US
Telephone Number	:	207-650-0264
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 EASTLAWN RD
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1912
Country	:	US
Telephone Number	:	207-650-0264
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/28/2023

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