Provider Demographics
NPI:1134398050
Name:GOSSELIN, LISA ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CLEARING FARM RD.
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364
Mailing Address - Country:US
Mailing Address - Phone:781-585-2927
Mailing Address - Fax:
Practice Address - Street 1:64 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4881
Practice Address - Country:US
Practice Address - Phone:508-747-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist