Provider Demographics
NPI:1528406469
Name:SAMET, ALYSSA BRENNA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BRENNA
Last Name:SAMET
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1620
Mailing Address - Country:US
Mailing Address - Phone:336-707-9886
Mailing Address - Fax:
Practice Address - Street 1:341 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1620
Practice Address - Country:US
Practice Address - Phone:336-707-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist