Provider Demographics
NPI:1689282964
Name:VISLOCKY, ALICIA VERONICA
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:VERONICA
Last Name:VISLOCKY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:VERONICA
Other - Last Name:SUPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:167 MYERS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3869
Mailing Address - Country:US
Mailing Address - Phone:845-298-2090
Mailing Address - Fax:845-897-3753
Practice Address - Street 1:167 MYERS CORNERS RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3869
Practice Address - Country:US
Practice Address - Phone:845-298-2090
Practice Address - Fax:845-764-9009
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist