Individual
GRAY SYCAMORE MERCURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
170 US ROUTE 1 STE 100, FALMOUTH, ME 04105-2154
(207) 781-0022
Mailing address
132 MARGINAL WAY APT 453, PORTLAND, ME 04101-7423
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
7287
TN
235Z00000X
Speech-Language Pathologist
SLP010840
GA
235Z00000X
Speech-Language Pathologist
Primary
SP3959
ME
Other
Enumeration date
10/08/2020
Last updated
09/21/2023
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