Provider Demographics
NPI:1386229409
Name:WINDOM, ALYSSA L (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:L
Last Name:WINDOM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W UNIVERSITY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7418
Mailing Address - Country:US
Mailing Address - Phone:972-984-1050
Mailing Address - Fax:972-984-1376
Practice Address - Street 1:4001 W 15TH ST STE 225
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5838
Practice Address - Country:US
Practice Address - Phone:972-984-1050
Practice Address - Fax:972-984-1376
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A