Provider Demographics
NPI:1104968312
Name:LALONE, DALE T (MS CCC-A)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:T
Last Name:LALONE
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2432
Mailing Address - Country:US
Mailing Address - Phone:207-828-9590
Mailing Address - Fax:207-828-1049
Practice Address - Street 1:260 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2432
Practice Address - Country:US
Practice Address - Phone:207-828-9590
Practice Address - Fax:207-828-1049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP159231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
367490OtherCIGNA
1042010OtherAETNA
7303080Y0NHOtherANTHEM - NH
MNT752OtherHARVARD PILGRIM
NH30006549Medicaid
NH30006549Medicaid