MEDICARE: MS. ELIZABETH ANN SPENCE 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	SP345	ME

General Provider Information

NPI Number	:	1619202462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANN SPENCE 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	:	712 LAKEVIEW DR
Second Line	:
City	:	SOUTH CHINA
State	:	ME
Zip	:	04358-4314
Country	:	US
Telephone Number	:	207-445-4800
Fax Number	:

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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