MEDICARE: MS. EMILY LOU ISOM M.S. 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	SP441	ME

General Provider Information

NPI Number	:	1366776536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY LOU ISOM M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	899 RIVERSIDE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1070
Country	:	US
Telephone Number	:	207-871-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 W POWNAL RD
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6819
Country	:	US
Telephone Number	:	207-829-9120
Fax Number	:

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

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/22/2009

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Directions to “ MS. EMILY LOU ISOM M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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