Individual
VIRGINIA RUSSELL MUJICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
41 PINE HILL RD, CASCO, ME 04015-4138
(207) 650-2271
Mailing address
41 PINE HILL RD, CASCO, ME 04015-4138
(207) 650-2271
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP795
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205240000
—
ME
Enumeration date
11/26/2007
Last updated
11/26/2007
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