Provider Demographics
NPI:1063456481
Name:TASSE, LAURA LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:TASSE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:100 CROSSING BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5555
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:100 CROSSING BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5555
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:339-686-2561
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA513231H00000X
CT000297231H00000X
PAAT001172L231H00000X
NY002183-1231H00000X
RIAUD00203231H00000X
TX51651231H00000X
MA396231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1063456481Medicaid
NH3078788Medicaid
MA110062743AMedicaid
TX174257902Medicaid
TX8F21133Medicare PIN
NH046264Medicare PIN
MA110062743AMedicaid
MAQX1153Medicare PIN
PA050875XK1Medicare PIN
CT1063456481Medicaid
NH3078788Medicaid