Provider Demographics
NPI:1093322430
Name:BANKS, ALYSSA CAJKA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CAJKA
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:CAJKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 BELFAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8040
Mailing Address - Country:US
Mailing Address - Phone:803-629-1981
Mailing Address - Fax:803-825-4830
Practice Address - Street 1:108 BELFAIR RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8040
Practice Address - Country:US
Practice Address - Phone:803-629-1981
Practice Address - Fax:803-825-4830
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist