Provider Demographics
NPI:1518098532
Name:TESSIER, LISA A (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:TESSIER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WALKER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1727
Mailing Address - Country:US
Mailing Address - Phone:207-351-3525
Mailing Address - Fax:207-351-3524
Practice Address - Street 1:35 WALKER ST STE 200
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1727
Practice Address - Country:US
Practice Address - Phone:207-351-3525
Practice Address - Fax:207-351-3524
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1077231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30433298Medicaid
ME270050099Medicaid
NH30433298Medicaid