Provider Demographics
NPI:1255690863
Name:MAKUTA, ALICIA MARIE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:MAKUTA
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 1:9 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1851
Mailing Address - Country:US
Mailing Address - Phone:610-670-8600
Mailing Address - Fax:
Practice Address - Street 1:9 BRISTOL CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist