Healthcare Provider Details

I. General information

NPI: 1528080660
Provider Name (Legal Business Name): LISA RACKLIFFE GOSSELIN MS,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RACKLIFFE

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL PARK DRIVE
CONCORD NH
03301
US

IV. Provider business mailing address

2 INDUSTRIAL PARK DRIVE
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9043
  • Fax: 603-228-2133
Mailing address:
  • Phone: 603-224-9043
  • Fax: 603-228-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number063-0000118
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA448
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: