Provider Demographics
NPI:1528080660
Name:GOSSELIN, LISA RACKLIFFE (MS,CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RACKLIFFE
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:RACKLIFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-224-9043
Mailing Address - Fax:603-228-2133
Practice Address - Street 1:2 INDUSTRIAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-224-9043
Practice Address - Fax:603-228-2133
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT063-0000118231H00000X
NHA448231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010959Medicaid
NH30436067Medicaid
NH30436067Medicaid
VTF67475Medicare UPIN
02066401Medicare PIN