Healthcare Provider Details

I. General information

NPI: 1023490182
Provider Name (Legal Business Name): ERICA PENNESI WISSEL AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S # 626
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1508B WARD AVE
NASHVILLE TN
37206-2238
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-7970
  • Fax:
Mailing address:
  • Phone: 865-591-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number004010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: