Provider Demographics
NPI:1033635792
Name:WEST, ALYSON CAROL (MS CCC, SLP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:CAROL
Last Name:WEST
Suffix:
Gender:F
Credentials:MS CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MARYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5144
Mailing Address - Country:US
Mailing Address - Phone:618-451-5800
Mailing Address - Fax:618-451-0398
Practice Address - Street 1:4651 MARYVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2516
Practice Address - Country:US
Practice Address - Phone:618-931-2044
Practice Address - Fax:618-931-6042
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist