Provider Demographics
NPI:1427350685
Name:DIERSING, ALYSSA LORRAINE (AUD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LORRAINE
Last Name:DIERSING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LORRAINE
Other - Last Name:UHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:1311 S UNION AVE # 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1959
Mailing Address - Country:US
Mailing Address - Phone:800-500-8243
Mailing Address - Fax:
Practice Address - Street 1:1940 116TH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3011
Practice Address - Country:US
Practice Address - Phone:800-500-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2757237600000X
WALD61275344231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFU490ZMedicare Oscar/Certification