Organization
AOS 92
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA THIBEAU MA, CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(207) 872-1967
Entity
Organization
Contact information
Practice address
20 DEAN ST, WINSLOW, ME 04901-6738
(207) 872-1967
Mailing address
20 DEAN ST, WINSLOW, ME 04901-6738
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1099
ME
Other
Enumeration date
08/25/2010
Last updated
08/25/2010
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