Provider Demographics
NPI:1164458568
Name:PREWITT, ALISA Y (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:Y
Last Name:PREWITT
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 1:5850 CANOGA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6554
Mailing Address - Country:US
Mailing Address - Phone:323-924-9464
Mailing Address - Fax:281-392-8239
Practice Address - Street 1:5850 CANOGA AVE STE 400
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6554
Practice Address - Country:US
Practice Address - Phone:323-924-9464
Practice Address - Fax:281-392-8239
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21346235Z00000X
TX100951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160513102Medicaid
TX47-0905996OtherEIN
TX9363664Medicare UPIN
TX80314Medicare UPIN
TX11121882Medicare UPIN
TX160513102Medicaid
TX87431TMedicare UPIN
TX7790648Medicare UPIN
TX2194983Medicare UPIN