Basic Information
| Provider Information | |||||||||
| NPI: | 1518479971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STREISEL | ||||||||
| FirstName: | ELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 COLLEGE PKWY | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054463013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028473970 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2017 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 144.0132660 | VT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.