Doctor Name: | JADE GRAYCE PEDRICK |
NPI Number: | 1780992701 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | ST2061 |
Business Practice Address: | 8 Noble Ln Berwick, ME - 039012842 |
Business Phone Number: | 2076981188 |
Business Fax Number: | |
Mailing Address: | 119 Spinnaker Way, PORTSMOUTH |
State: | NH |
Postal Code: | 038013369 |
Phone Number: | 5186692714 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2010 |
NPI Last Update Date: | 09/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | ST2061 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |