Provider Demographics
NPI:1164688628
Name:CORNELIUS, ALISON E (SLP-A)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:E
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7932
Mailing Address - Country:US
Mailing Address - Phone:904-733-5034
Mailing Address - Fax:
Practice Address - Street 1:9471 BAYMEADOWS RD
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7932
Practice Address - Country:US
Practice Address - Phone:904-733-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI15522355S0801X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist