Provider Demographics
NPI:1467780213
Name:WALDMANN, ALISON GRADY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:GRADY
Last Name:WALDMANN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3740
Mailing Address - Country:US
Mailing Address - Phone:860-350-4763
Mailing Address - Fax:
Practice Address - Street 1:19 MEADOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3740
Practice Address - Country:US
Practice Address - Phone:860-350-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist