Provider Demographics
NPI:1093290587
Name:HIRSH, ALYSSA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:HIRSH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 N OAKLEY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4741
Mailing Address - Country:US
Mailing Address - Phone:847-417-0676
Mailing Address - Fax:
Practice Address - Street 1:1845 OAK ST STE 15
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3022
Practice Address - Country:US
Practice Address - Phone:847-386-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146014480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist