Provider Demographics
NPI:1083731707
Name:WEISS, ALLISON (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3042
Mailing Address - Country:US
Mailing Address - Phone:585-271-0680
Mailing Address - Fax:585-442-4114
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-0680
Practice Address - Fax:585-442-4114
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA831231H00000X
NY002291231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9732641Medicaid
MA041064Medicare ID - Type UnspecifiedGROUP NUMBER