Provider Demographics
NPI:1255860367
Name:WADLEY, ALYSSA RENEE (HIS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENEE
Last Name:WADLEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 S. IH-35
Mailing Address - Street 2:ATTN: HEARING CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3885
Mailing Address - Country:US
Mailing Address - Phone:512-582-4887
Mailing Address - Fax:
Practice Address - Street 1:9900 S IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3885
Practice Address - Country:US
Practice Address - Phone:512-582-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80780237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist