Healthcare Provider Details

I. General information

NPI: 1760763544
Provider Name (Legal Business Name): DENISE CHISARI M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 MAIN ST
FRYEBURG ME
04037-1146
US

IV. Provider business mailing address

568 MAIN ST
FRYEBURG ME
04037-1146
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-3500
  • Fax: 207-935-7384
Mailing address:
  • Phone: 207-935-3500
  • Fax: 207-935-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1313
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: