Individual
AMY L BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
797 WILSON ST STE 2, BREWER, ME 04412-1003
(207) 947-8493
(207) 990-4819
Mailing address
797 WILSON ST STE 2, BREWER, ME 04412-1003
(207) 947-8493
(207) 990-4819
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP825
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024794
ANTHEM
ME
05
—
252520099
—
ME
Enumeration date
11/17/2006
Last updated
09/12/2023
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