Individual
LIELA BANKS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
88 MAPLE ST, BANGOR, ME 04401-5407
(207) 945-5581
Mailing address
88 MAPLE ST, BANGOR, ME 04401-5407
(207) 945-5581
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1576
ME
Other
Enumeration date
08/08/2007
Last updated
08/08/2007
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