Provider Demographics
NPI:1093590945
Name:DEEMS, ALLYSSA LEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:LEIGH
Last Name:DEEMS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 ROAD 122
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5891
Mailing Address - Country:US
Mailing Address - Phone:616-307-4603
Mailing Address - Fax:
Practice Address - Street 1:1315 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4174
Practice Address - Country:US
Practice Address - Phone:616-307-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61429564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist