Individual
KIRK MAURICE FONGEMIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1133 WASHINGTON AVE, PORTLAND, ME 04103-3629
(207) 797-0600
Mailing address
1133 WASHINGTON AVE, PORTLAND, ME 04103-3629
(207) 797-0600
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2539
ME
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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