Provider Demographics
NPI:1275788077
Name:CHIASSON, CARL RAYMOND (AUD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RAYMOND
Last Name:CHIASSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492
Mailing Address - Country:US
Mailing Address - Phone:315-765-6935
Mailing Address - Fax:315-765-8017
Practice Address - Street 1:113 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492
Practice Address - Country:US
Practice Address - Phone:315-765-6935
Practice Address - Fax:315-765-8017
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY800-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist