Provider Demographics
NPI:1437603784
Name:REVES, ALYSON DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:DAWN
Last Name:REVES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:ALYSON
Other - Middle Name:DAWN
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10401 COUNTY ROAD 1016
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7625
Mailing Address - Country:US
Mailing Address - Phone:817-937-1522
Mailing Address - Fax:866-606-8577
Practice Address - Street 1:10401 COUNTY ROAD 1016
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7625
Practice Address - Country:US
Practice Address - Phone:817-937-1522
Practice Address - Fax:866-606-8577
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist