Provider Demographics
NPI:1871574939
Name:RANCOURT, MARY ELLEN (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:RANCOURT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARY ELLEN
Other - Middle Name:
Other - Last Name:CURRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1132
Mailing Address - Country:US
Mailing Address - Phone:774-293-1515
Mailing Address - Fax:774-293-1315
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01560-1132
Practice Address - Country:US
Practice Address - Phone:774-293-1515
Practice Address - Fax:774-293-1315
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA469231H00000X
RIAUD00205231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1972629459OtherBCBSRI
RI2026;1140DOtherNHP RI
MAAD0014OtherBCBSMA
MA5102634Medicaid
RI050258937OtherTRICARE / HNF
MA701262OtherTUFTS
RI1972629459OtherBCBSRI