Provider Demographics
NPI:1174757991
Name:FAGAN CENTER FOR COMMUNICATON LLC
Entity type:Organization
Organization Name:FAGAN CENTER FOR COMMUNICATON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:207-939-7072
Mailing Address - Street 1:985 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3303
Mailing Address - Country:US
Mailing Address - Phone:207-797-2351
Mailing Address - Fax:207-839-2197
Practice Address - Street 1:985 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3303
Practice Address - Country:US
Practice Address - Phone:207-797-2351
Practice Address - Fax:207-839-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty