Provider Demographics
NPI:1053819540
Name:FAMULINER, ALYSSA PAIGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:PAIGE
Last Name:FAMULINER
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 1:1932 LASSO CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4886
Mailing Address - Country:US
Mailing Address - Phone:660-815-3959
Mailing Address - Fax:
Practice Address - Street 1:1932 LASSO CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4886
Practice Address - Country:US
Practice Address - Phone:660-815-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014028779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist