Provider Demographics
NPI:1417247008
Name:MACCLEERY, ALISON F
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:F
Last Name:MACCLEERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:F
Other - Last Name:FELLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:3008B BERKMAR DR
Mailing Address - Street 2:CHARLOTTESVILLE
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1443
Mailing Address - Country:US
Mailing Address - Phone:434-973-5031
Mailing Address - Fax:434-973-0520
Practice Address - Street 1:3008B BERKMAR DR
Practice Address - Street 2:CHARLOTTESVILLE
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1443
Practice Address - Country:US
Practice Address - Phone:434-973-5031
Practice Address - Fax:434-973-0520
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978056Medicaid
VA496513Medicare PIN