Provider Demographics
NPI:1760763544
Name:CHISARI, DENISE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CHISARI
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037-1146
Mailing Address - Country:US
Mailing Address - Phone:207-935-3500
Mailing Address - Fax:207-935-7384
Practice Address - Street 1:568 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1146
Practice Address - Country:US
Practice Address - Phone:207-935-3500
Practice Address - Fax:207-935-7384
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist