Healthcare Provider Details

I. General information

NPI: 1356741227
Provider Name (Legal Business Name): ALISON YEAGER NISBET M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 HIGH ST APT 1
SOUTH PORTLAND ME
04106-1579
US

IV. Provider business mailing address

58 HIGH ST APT 1
SOUTH PORTLAND ME
04106-1579
US

V. Phone/Fax

Practice location:
  • Phone: 202-361-7425
  • Fax:
Mailing address:
  • Phone: 202-361-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP2497
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: