Provider Demographics
NPI:1205276672
Name:EASTMAN, ALYSSA M (AUD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:M
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:BONNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5724
Mailing Address - Country:US
Mailing Address - Phone:603-626-7600
Mailing Address - Fax:
Practice Address - Street 1:87 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5724
Practice Address - Country:US
Practice Address - Phone:603-626-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA623231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist