Healthcare Provider Details

I. General information

NPI: 1063456481
Provider Name (Legal Business Name): LAURA LYNN TASSE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LYNN CONLEY AUD

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CROSSING BLVD SUITE 300
FRAMINGHAM MA
01702-5555
US

IV. Provider business mailing address

100 CROSSING BLVD SUITE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-6681
  • Fax: 339-686-2561
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA513
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000297
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT001172L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002183-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00203
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51651
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number396
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: