Provider Demographics
NPI:1932932027
Name:LATAILLE, MARIE-ANGE
Entity type:Individual
Prefix:
First Name:MARIE-ANGE
Middle Name:
Last Name:LATAILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 CONGRESS ST APT 419
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5178
Mailing Address - Country:US
Mailing Address - Phone:781-957-6095
Mailing Address - Fax:
Practice Address - Street 1:267 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-4494
Practice Address - Country:US
Practice Address - Phone:781-957-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME113461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist