Individual
JANE ELLEN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPL
Contact information
Practice address
284 CUMBERLAND AVE, PORTLAND, ME 04101-4927
(207) 874-8250
Mailing address
49 BROAD COVE RD, CAPE ELIZABETH, ME 04107-2901
(207) 799-6377
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
05
ME
Other
Enumeration date
08/26/2010
Last updated
08/26/2010
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