Provider Demographics
NPI:1902258817
Name:MERRILL, TESSA ARIEL (AUD)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:ARIEL
Last Name:MERRILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:DURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1652 E BOOKER DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9405
Mailing Address - Country:US
Mailing Address - Phone:410-760-8840
Mailing Address - Fax:410-760-8847
Practice Address - Street 1:203 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-760-8840
Practice Address - Fax:410-760-8847
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14450231H00000X
MD01390231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD448603000Medicaid