Provider Demographics
NPI:1295201341
Name:BARTLETT, ALYSSA M
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:BARTLETT
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 1:224 SE HOPE CT
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-6001
Mailing Address - Country:US
Mailing Address - Phone:503-268-7075
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST STE 305
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1570
Practice Address - Country:US
Practice Address - Phone:503-236-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10194729237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist