Provider Demographics
NPI:1639503501
Name:PARKER, ALYSSA C (SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:219 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8895
Mailing Address - Country:US
Mailing Address - Phone:870-577-4524
Mailing Address - Fax:
Practice Address - Street 1:3291 S THOMPSON ST STE F101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7342
Practice Address - Country:US
Practice Address - Phone:479-750-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist