Provider Demographics
NPI:1639506074
Name:WALSH, ALICIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 GONI RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7972
Mailing Address - Country:US
Mailing Address - Phone:775-687-0100
Mailing Address - Fax:
Practice Address - Street 1:3427 GONI RD STE 104
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7972
Practice Address - Country:US
Practice Address - Phone:775-687-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist