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Individual

ELLEN H DECOTIIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S.L.P

Contact information

Practice address
78 DEPOT ST, BAR MILLS, ME 04004
(207) 809-9496
(207) 839-2197
Mailing address
PO BOX 608, BAR MILLS, ME 04004-0608
(207) 929-4104

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP439
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001035
ANTHEM BLUE CROSS
ME
05
224340000
ME
Enumeration date
08/05/2006
Last updated
10/11/2018
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