Provider Demographics
NPI:1275244022
Name:GONNELLA, ALYSSA D
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WALNUT VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3236
Mailing Address - Country:US
Mailing Address - Phone:301-751-1137
Mailing Address - Fax:
Practice Address - Street 1:9480 S EASTERN AVE STE 273
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8000
Practice Address - Country:US
Practice Address - Phone:702-463-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist