Individual
MS. KATHARINE J DISALVATORE FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
700 MOUNT HOPE AVE STE 320, BANGOR, ME 04401-5680
(207) 941-2952
(207) 941-2955
Mailing address
700 MOUNT HOPE AVE STE 320, BANGOR, ME 04401-5680
(207) 941-2952
(207) 941-2955
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1742
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251820099
—
ME
Enumeration date
11/15/2006
Last updated
01/11/2017
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