Provider Demographics
NPI:1578682571
Name:GREER, ALISSA M (M A CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:M
Last Name:GREER
Suffix:
Gender:F
Credentials:M A CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4622 BERWYN LN
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8252
Practice Address - Country:US
Practice Address - Phone:610-349-0169
Practice Address - Fax:610-366-7455
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016600090001Medicaid