Provider Demographics
NPI:1346130671
Name:IKEDA, ALYSSA MIKAE
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:MIKAE
Last Name:IKEDA
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 1:1635 CHALCEDONY CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7321
Mailing Address - Country:US
Mailing Address - Phone:916-467-6798
Mailing Address - Fax:
Practice Address - Street 1:4282 GENESEE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4986
Practice Address - Country:US
Practice Address - Phone:619-207-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist