Healthcare Provider Details

I. General information

NPI: 1083833578
Provider Name (Legal Business Name): ALISSA GAUVIN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISSA DUSSEAULT MS CCC-SLP

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 DEXTER ST
CENTRAL FALLS RI
02863-2742
US

IV. Provider business mailing address

621 DEXTER ST
CENTRAL FALLS RI
02863-2742
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4300
  • Fax:
Mailing address:
  • Phone: 401-276-4300
  • Fax: 401-886-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP00540
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: