Provider Demographics
NPI:1518434810
Name:KUNG-GUNION, ALYSSA NOELLE NOVALES (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NOELLE NOVALES
Last Name:KUNG-GUNION
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 1:38111 OLD CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-0310
Mailing Address - Country:US
Mailing Address - Phone:951-290-8147
Mailing Address - Fax:
Practice Address - Street 1:198 CIRBY WAY STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6430
Practice Address - Country:US
Practice Address - Phone:916-773-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist