Provider Demographics
NPI:1518700129
Name:TESTA, MADELINE FAYE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:FAYE
Last Name:TESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST UNIT 22
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1340
Mailing Address - Country:US
Mailing Address - Phone:207-356-9537
Mailing Address - Fax:888-373-3494
Practice Address - Street 1:94 MAIN ST UNIT 22
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1340
Practice Address - Country:US
Practice Address - Phone:207-356-9537
Practice Address - Fax:888-373-3494
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST4119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist