Provider Demographics
NPI:1477169357
Name:BOOK, ALYSSA KATLIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATLIN
Last Name:BOOK
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 1:2555 N CLARK ST APT 608
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1723
Mailing Address - Country:US
Mailing Address - Phone:812-989-6449
Mailing Address - Fax:
Practice Address - Street 1:1422 W WILLOW ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8977
Practice Address - Country:US
Practice Address - Phone:312-399-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist