Individual
LISA MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC/SLP
Contact information
Practice address
196 ALLEN AVE, PORTLAND, ME 04103-3711
(207) 874-8133
Mailing address
196 ALLEN AVE, PORTLAND, ME 04103-3711
(207) 874-8133
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1475
ME
Other
Enumeration date
06/24/2008
Last updated
10/27/2010
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