Provider Demographics
NPI:1265665426
Name:ESTORNELL, ALYSSA LIANA (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LIANA
Last Name:ESTORNELL
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 1:311 LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4619
Mailing Address - Country:US
Mailing Address - Phone:561-588-5162
Mailing Address - Fax:
Practice Address - Street 1:2963 WERWOOD CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-7680
Practice Address - Country:US
Practice Address - Phone:561-635-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist