Individual
MADELEINE PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
117 SUMMIT TER APT 91, SOUTH PORTLAND, ME 04106-2276
(413) 386-5358
Mailing address
117 SUMMIT TER APT 91, SOUTH PORTLAND, ME 04106-2276
(413) 386-5358
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP4353
ME
Other
Enumeration date
07/17/2025
Last updated
07/17/2025
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