Provider Demographics
NPI:1275837429
Name:DIAZ-KLEINE, ALYSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:DIAZ-KLEINE
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 1:8 KLEIN CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3751
Mailing Address - Country:US
Mailing Address - Phone:314-989-8869
Mailing Address - Fax:314-989-8870
Practice Address - Street 1:10094 LITZSINGER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1132
Practice Address - Country:US
Practice Address - Phone:314-989-8869
Practice Address - Fax:314-989-8870
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist