Provider Demographics
NPI:1013551290
Name:MCANINCH, ALYSSA SWENSON
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SWENSON
Last Name:MCANINCH
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 1:21412 BOONE DR
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-0120
Mailing Address - Country:US
Mailing Address - Phone:936-462-3799
Mailing Address - Fax:
Practice Address - Street 1:19998 SADDLEBROOK DR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-6382
Practice Address - Country:US
Practice Address - Phone:903-882-6400
Practice Address - Fax:903-882-6404
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist