Provider Demographics
NPI:1093139511
Name:ALISA PREWITT AND ASSOCIATES
Entity Type:Organization
Organization Name:ALISA PREWITT AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:281-392-8173
Mailing Address - Street 1:22507 MOSSY TRAILS CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2255
Mailing Address - Country:US
Mailing Address - Phone:281-392-8173
Mailing Address - Fax:281-392-8239
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8432
Practice Address - Country:US
Practice Address - Phone:281-392-8173
Practice Address - Fax:281-392-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160513102Medicaid