Provider Demographics
NPI:1083091078
Name:LORD, ALYSSA (MS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 OSUNA RD NE
Mailing Address - Street 2:APT 708
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2567
Mailing Address - Country:US
Mailing Address - Phone:617-759-2918
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD. NE
Practice Address - Street 2:SLS CENTER - 3RD FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-272-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist