Provider Demographics
NPI:1356652929
Name:BRISSON, MARYELLEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARYELLEN
Middle Name:
Last Name:BRISSON
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 1:255 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2308
Mailing Address - Country:US
Mailing Address - Phone:310-372-2401
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4500
Practice Address - Country:US
Practice Address - Phone:310-540-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU604237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter