Provider Demographics
NPI:1891923470
Name:LIGHT, AIMEE EB (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:EB
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:ELIZABETH
Other - Last Name:BABINEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:23 FREDERIC ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2769
Mailing Address - Country:US
Mailing Address - Phone:617-997-6096
Mailing Address - Fax:207-730-5229
Practice Address - Street 1:23 FREDERIC ST
Practice Address - Street 2:APT. 2
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2769
Practice Address - Country:US
Practice Address - Phone:617-997-6096
Practice Address - Fax:207-730-5229
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist