Provider Demographics
NPI:1992927099
Name:HEDBERG, ADAM ERIC (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ERIC
Last Name:HEDBERG
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104
Mailing Address - Country:US
Mailing Address - Phone:207-774-6323
Mailing Address - Fax:207-761-8460
Practice Address - Street 1:618 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-6110
Practice Address - Fax:207-795-6189
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
100031OtherANTHEM