Provider Demographics
NPI:1326707811
Name:ERIQUEZZO, ALYSSA MORGAN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MORGAN
Last Name:ERIQUEZZO
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 1:207 SEWELL RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1858
Mailing Address - Country:US
Mailing Address - Phone:404-314-6693
Mailing Address - Fax:
Practice Address - Street 1:207 SEWELL RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-1858
Practice Address - Country:US
Practice Address - Phone:404-314-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist