Provider Demographics
NPI:1073034229
Name:ESCOBAR, ALYSSA (SLPA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 PEONY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7338
Mailing Address - Country:US
Mailing Address - Phone:951-255-6677
Mailing Address - Fax:
Practice Address - Street 1:2129 PEONY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7338
Practice Address - Country:US
Practice Address - Phone:951-255-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA43692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00114421282OtherKAISER PERMANENTE