Basic Information
| Provider Information | |||||||||
| NPI: | 1316180938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLLARD | ||||||||
| FirstName: | PENELOPE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SHORE RD 326 | ||||||||
| Address2: | |||||||||
| City: | CAPE ELIZABETH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041071916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078990383 | ||||||||
| FaxNumber: | 2075189563 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 BRAZIER LN | ||||||||
| Address2: | |||||||||
| City: | KENNEBUNK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040437095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079853030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | ST1829 | ME | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.