Provider Demographics
NPI:1386886323
Name:SOUTHERN MAINE SPEECH & LANGUAGE SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHERN MAINE SPEECH & LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:207-893-1599
Mailing Address - Street 1:32 TANDBERG TRL UNIT 7
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-6417
Mailing Address - Country:US
Mailing Address - Phone:207-893-1599
Mailing Address - Fax:207-591-4636
Practice Address - Street 1:32 TANDBERG TRL UNIT 7
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6417
Practice Address - Country:US
Practice Address - Phone:207-893-1599
Practice Address - Fax:207-591-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133870000Medicaid
1023123601OtherINDIVIDUAL NPI