Provider Demographics
NPI:1477905743
Name:OLVERA, ALYSIA (MS, SLP-CF)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 N FOXDALE DR UNIT 300
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5505
Mailing Address - Country:US
Mailing Address - Phone:630-290-6296
Mailing Address - Fax:
Practice Address - Street 1:1210 N FOXDALE DR UNIT 300
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5505
Practice Address - Country:US
Practice Address - Phone:630-290-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist