Provider Demographics
NPI:1205216447
Name:AUSTIN, ALYSSA (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:
Last Name:AUSTIN
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 1:28786 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2512
Mailing Address - Country:US
Mailing Address - Phone:440-278-0628
Mailing Address - Fax:
Practice Address - Street 1:28786 ALTON RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2512
Practice Address - Country:US
Practice Address - Phone:440-278-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist