Provider Demographics
NPI:1528620184
Name:BOESIGER, TESSA (AUD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:BOESIGER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203A BARKLEY MEMORIAL CENTER
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0731
Mailing Address - Country:US
Mailing Address - Phone:402-472-2071
Mailing Address - Fax:402-472-3814
Practice Address - Street 1:203A BARKLEY MEMORIAL CENTER
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0731
Practice Address - Country:US
Practice Address - Phone:402-472-2071
Practice Address - Fax:402-472-3814
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81187231HA2400X, 231H00000X
NE437231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty