Individual ProviderMeredith Leigh PetersenSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address22 Bramhall St, Portland, ME 04102-3134(207) 329-9144PECOS EnrollmentBased on the most recent information from CMS, provider Meredith Leigh Petersen does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1912537861Provider TypeIndividualFull NamePetersen, Meredith LeighCredentialM.S. CCC SLPGenderFemaleSole ProprietorNoEnumeration Date1/20/2020Last Updated1/20/2020Contact InformationPractice LocationPractice Address22 Bramhall St, Portland, ME 04102-3134Phone(207) 329-9144FaxUnlisted FaxMailing LocationMailing Address14 Baltimore Ave, South Portland, ME 04106-4420Phone(207) 329-9144FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseSP2208Maine