Provider Demographics
NPI:1619455730
Name:HIDALGO, ALISA ANN (MS CCC-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:ANN
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MADISON ST APT 611
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6490
Mailing Address - Country:US
Mailing Address - Phone:781-864-7803
Mailing Address - Fax:
Practice Address - Street 1:1001 MADISON ST APT 611
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6490
Practice Address - Country:US
Practice Address - Phone:781-864-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026135235Z00000X
MA76311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty