Provider Demographics
NPI:1417695644
Name:BARNES, ALYSSA LYNNE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LYNNE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:164 N PRAIRIE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-9303
Mailing Address - Country:US
Mailing Address - Phone:845-866-6118
Mailing Address - Fax:
Practice Address - Street 1:150 SOUTHPARK BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5179
Practice Address - Country:US
Practice Address - Phone:845-866-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist