Individual
ALISA FUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10131 HIGHWAY 53 W, BURGAW, NC 28425
(910) 471-0111
Mailing address
10131 HWY 53 W, BURGAW, NC 28425
(910) 471-0111
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11983
NC
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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