Provider Demographics
NPI:1659085389
Name:DAMSCHRODER, ALISSA (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:DAMSCHRODER
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:GALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:9457 IRON MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7722
Mailing Address - Country:US
Mailing Address - Phone:727-204-1986
Mailing Address - Fax:
Practice Address - Street 1:9457 IRON MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7722
Practice Address - Country:US
Practice Address - Phone:727-204-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12003192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist