Provider Demographics
NPI:1881931343
Name:GUSSMANN, KARISSA A (SLP)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:A
Last Name:GUSSMANN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:A
Other - Last Name:GUSSMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:609 FORT WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5925
Mailing Address - Country:US
Mailing Address - Phone:908-770-5990
Mailing Address - Fax:
Practice Address - Street 1:609 FORT WILLIAM DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-5925
Practice Address - Country:US
Practice Address - Phone:908-770-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00689400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist