Provider Demographics
NPI:1407594187
Name:D'ANTONIO, ALICIA MARIE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4322
Mailing Address - Country:US
Mailing Address - Phone:610-476-0170
Mailing Address - Fax:
Practice Address - Street 1:29 NORTHWOOD RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4322
Practice Address - Country:US
Practice Address - Phone:610-476-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty