Provider Demographics
NPI:1285894915
Name:HENCH, ALISSA B (AU D)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:B
Last Name:HENCH
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WELLS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3344
Mailing Address - Country:US
Mailing Address - Phone:617-969-4327
Mailing Address - Fax:617-969-4326
Practice Address - Street 1:181 WELLS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3344
Practice Address - Country:US
Practice Address - Phone:617-969-4327
Practice Address - Fax:617-969-4326
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1465231H00000X
MA1004231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAT4402Medicare UPIN