Active NPI
Julie Fagone
- Speech-Language Pathologist
- Portland, ME
National Provider Identifier
1144363789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP1590
- Practice address
- 125 Presumpscot St
Portland, ME 04103-5225 - Phone
- (207) 828-5355
- NPI assigned
- Feb 14, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP1590 | ME | Primary |
Addresses
Primary practice location
125 Presumpscot St
Portland, ME 04103-5225
Mailing address
30 Mountview Drive
Gorham, ME 04038
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048501 | Other | ME | ANTHEM MAINE |
| 1284063 | Other | ME | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP1590 | ME | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1144363789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 MOUNTVIEW DRIVE",
"city": "GORHAM",
"state": "ME",
"postal_code": "04038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 PRESUMPSCOT ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041035225",
"telephone_number": "207-828-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGONE",
"first_name": "JULIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ME",
"license": "SP1590",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM MAINE",
"identifier": "048501",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1284063",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
- Jason Ishmael Ezzy, LMT, AHS
- Fagan Center for Communicaton LLC (Elizabeth Fagan)
- Elizabeth Anne Fagan, SLPD
- Roger Fagan, AUD
- Kylie Fagnano, MS, RDN, LDN
- Laura J. Faherty, M.D., M.P.H., M.S.H.
- Patricia Fahey, FNP
- Kathleen McPherson Fairfield, M.D.
- Wesley P Fairfield, MD, ECNU
- Eleanor Littlefield Falby
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.