Provider Demographics
NPI:1003206905
Name:DUNLAP, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 32ND ST UNIT 12
Mailing Address - Street 2:UNIT #12
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4575
Mailing Address - Country:US
Mailing Address - Phone:760-685-2268
Mailing Address - Fax:
Practice Address - Street 1:4431 32ND ST UNIT 12
Practice Address - Street 2:UNIT #12
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4575
Practice Address - Country:US
Practice Address - Phone:760-685-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01122305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist