Provider Demographics
NPI:1619487584
Name:DEFLORIO, ALYSSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEFLORIO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1132
Mailing Address - Country:US
Mailing Address - Phone:847-347-5989
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE STE 109
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:773-318-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist