MEDICARE: CHRISTINE M FOURNIER SLPA

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	2355S0801X	Speech-Language Assistant	235550801X	ME

General Provider Information

NPI Number	:	1730488636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M FOURNIER SLPA

Provider Business Mailing Address
First Line	:	143 MT TOM RD
Second Line	:
City	:	PEMBROKE
State	:	ME
Zip	:	04666-4702
Country	:	US
Telephone Number	:	207-726-5016
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 MT TOM RD
Second Line	:
City	:	PEMBROKE
State	:	ME
Zip	:	04666-4702
Country	:	US
Telephone Number	:	207-726-5016
Fax Number	:

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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