Provider Demographics
NPI:1437693041
Name:CZERNIEJEWSKI, ALISON (M A CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:CZERNIEJEWSKI
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 WHIG HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-7706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 WHIG HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-7706
Practice Address - Country:US
Practice Address - Phone:419-290-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8683235Z00000X
MI7101004057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist