Provider Demographics
NPI:1316068588
Name:CLIFFORD, MARY CLARE (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLARE
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:M.
Other - Middle Name:CLARE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:133 LIBBY RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:ME
Mailing Address - Zip Code:04069-6332
Mailing Address - Country:US
Mailing Address - Phone:207-462-2058
Mailing Address - Fax:
Practice Address - Street 1:133 LIBBY RD
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:ME
Practice Address - Zip Code:04069-6332
Practice Address - Country:US
Practice Address - Phone:207-558-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME233420099Medicaid
ME233420000Medicaid
ME2875611OtherCIGNA
ME043865OtherANTHEM BLUE CROSS
ME7892683OtherAETNA