Provider Demographics
NPI:1083687370
Name:TUCKER, ALISON MARSH (M ED CCCSLP CERT AVT)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARSH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:M ED CCCSLP CERT AVT
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:MARSH
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED CCCSLP CERT AVT
Mailing Address - Street 1:1875 CENTURY BLVD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3314
Mailing Address - Country:US
Mailing Address - Phone:404-633-8911
Mailing Address - Fax:404-633-6403
Practice Address - Street 1:1875 CENTURY BLVD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3314
Practice Address - Country:US
Practice Address - Phone:404-633-8911
Practice Address - Fax:404-633-6403
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA048342119AMedicaid