Provider Demographics
NPI:1093967093
Name:WALLACK, ALISON D (MS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:D
Last Name:WALLACK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 88TH ST
Mailing Address - Street 2:APT. 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6613
Mailing Address - Country:US
Mailing Address - Phone:917-751-3919
Mailing Address - Fax:
Practice Address - Street 1:404 E 88TH ST
Practice Address - Street 2:APT. 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6613
Practice Address - Country:US
Practice Address - Phone:917-751-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist