Provider Demographics
NPI:1649825753
Name:BASSEN, ALICE M (AUD CCC/A)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:BASSEN
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 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4124
Mailing Address - Country:US
Mailing Address - Phone:413-447-2225
Mailing Address - Fax:413-346-6798
Practice Address - Street 1:510 NORTH ST STE 6
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4117
Practice Address - Country:US
Practice Address - Phone:413-447-2225
Practice Address - Fax:413-346-6798
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA321237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter