Provider Demographics
NPI:1316384001
Name:ZUCKER, ALYSE PAIGE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:PAIGE
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 WARREN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1301
Mailing Address - Country:US
Mailing Address - Phone:617-635-8125
Mailing Address - Fax:
Practice Address - Street 1:443 WARREN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1301
Practice Address - Country:US
Practice Address - Phone:617-635-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA983231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist