Provider Demographics
NPI:1659983807
Name:LEBENBAUM, ALISON BLISS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:BLISS
Last Name:LEBENBAUM
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 1:2901 FALK RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6392
Mailing Address - Country:US
Mailing Address - Phone:360-313-3465
Mailing Address - Fax:
Practice Address - Street 1:2901 FALK RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6392
Practice Address - Country:US
Practice Address - Phone:360-313-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61079700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL61079700OtherWA SLP LICENSE