Provider Demographics
NPI:1326290693
Name:BUCK-VASQUEZ, ALLYSON ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:ELIZABETH
Last Name:BUCK-VASQUEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LAKEVIEW DR
Mailing Address - Street 2:APT. C10
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2237
Mailing Address - Country:US
Mailing Address - Phone:914-293-7977
Mailing Address - Fax:
Practice Address - Street 1:2 LAKEVIEW DR
Practice Address - Street 2:APT. C10
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2237
Practice Address - Country:US
Practice Address - Phone:914-293-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist