Provider Demographics
NPI:1083833578
Name:GAUVIN, ALISSA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:DUSSEAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:800 QUAKER LANE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-886-8642
Mailing Address - Fax:401-886-6632
Practice Address - Street 1:800 QUAKER LANE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-886-8642
Practice Address - Fax:401-886-6632
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
RISP00540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist