Basic Information
| Provider Information | |||||||||
| NPI: | 1598416257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALLS | ||||||||
| FirstName: | ZOE | ||||||||
| MiddleName: | SAYRE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS CFY-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SAYRE | ||||||||
| OtherFirstName: | ZOE | ||||||||
| OtherMiddleName: | CROWELL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 107 ALFRED RD | ||||||||
| Address2: | |||||||||
| City: | KENNEBUNK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040436182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737270403 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3 BRAZIER LN | ||||||||
| Address2: | |||||||||
| City: | KENNEBUNK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040436938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079853030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2022 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | ST3649 | ME | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.