Provider Demographics
NPI:1073988721
Name:ROUSSEAU, ALICIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BEL AIR PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5631
Mailing Address - Country:US
Mailing Address - Phone:615-714-8998
Mailing Address - Fax:
Practice Address - Street 1:513 BEL AIR PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5631
Practice Address - Country:US
Practice Address - Phone:615-714-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist