Provider Demographics
NPI:1619409406
Name:RANEY, ALYSSA JEAN (SLP-A/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEAN
Last Name:RANEY
Suffix:
Gender:F
Credentials:SLP-A/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JEAN
Other - Last Name:HAWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP-A/L
Mailing Address - Street 1:704 E 2ND AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1064
Mailing Address - Country:US
Mailing Address - Phone:928-856-2244
Mailing Address - Fax:
Practice Address - Street 1:704 E 2ND AVE APT C
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1064
Practice Address - Country:US
Practice Address - Phone:928-856-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA104872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant