Individual
JULIE FAGONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 PRESUMPSCOT ST, PORTLAND, ME 04103-5225
(207) 828-5355
Mailing address
30 MOUNTVIEW DRIVE, GORHAM, ME 04038
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1590
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048501
ANTHEM MAINE
ME
01
—
1284063
AETNA
ME
Enumeration date
02/14/2007
Last updated
07/09/2007
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