Provider Demographics
NPI:1083868236
Name:IANTOSCA, ALISSA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:IANTOSCA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E NOTRE DAME ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2950
Mailing Address - Country:US
Mailing Address - Phone:518-420-6462
Mailing Address - Fax:
Practice Address - Street 1:429 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2914
Practice Address - Country:US
Practice Address - Phone:518-824-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016068-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist