Provider Demographics
NPI:1245750009
Name:KOTH, ALYSSA KATE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:KATE
Last Name:KOTH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SOO MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2146
Mailing Address - Country:US
Mailing Address - Phone:262-613-8651
Mailing Address - Fax:
Practice Address - Street 1:RM 038 CPS 1901 FOURTH AVE
Practice Address - Street 2:UNVIERSITY OF WISCONSIN-STEVENS POINT
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-346-2328
Practice Address - Fax:715-346-2157
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist