Provider Demographics
NPI:1467844399
Name:DUTRA, ALANNA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:DUTRA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 HANCHETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2606
Mailing Address - Country:US
Mailing Address - Phone:707-834-6139
Mailing Address - Fax:
Practice Address - Street 1:1377 HANCHETT AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2606
Practice Address - Country:US
Practice Address - Phone:707-834-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist