Provider Demographics
NPI:1407259831
Name:OLIVO, ALISSA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:OLIVO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:MENDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 LEE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810
Mailing Address - Country:US
Mailing Address - Phone:407-730-6988
Mailing Address - Fax:407-730-6995
Practice Address - Street 1:933 LEE RD
Practice Address - Street 2:STE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-730-6988
Practice Address - Fax:407-730-6995
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist