Provider Demographics
NPI:1578277182
Name:MAYNOR, ALYSSA GRACE (MED CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GRACE
Last Name:MAYNOR
Suffix:
Gender:F
Credentials:MED CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 CROWN POINT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5967
Mailing Address - Country:US
Mailing Address - Phone:904-288-8910
Mailing Address - Fax:904-288-8912
Practice Address - Street 1:3663 CROWN POINT CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5967
Practice Address - Country:US
Practice Address - Phone:904-288-8910
Practice Address - Fax:904-288-8912
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist