Provider Demographics
NPI:1457627648
Name:MEHLTRETTER, ALYSSA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MEHLTRETTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SPINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5544 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5406
Mailing Address - Country:US
Mailing Address - Phone:716-580-3976
Mailing Address - Fax:716-580-3978
Practice Address - Street 1:5544 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5406
Practice Address - Country:US
Practice Address - Phone:716-580-3976
Practice Address - Fax:716-580-3978
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021777-1235Z00000X
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist