Provider Demographics
NPI:1700839867
Name:NATHISON, ALICIA BESS ANITA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:BESS ANITA
Last Name:NATHISON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10114 WHITEMARK LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7109
Mailing Address - Country:US
Mailing Address - Phone:919-467-8540
Mailing Address - Fax:
Practice Address - Street 1:319 CHAPANOKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3433
Practice Address - Country:US
Practice Address - Phone:919-662-4600
Practice Address - Fax:919-662-4473
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist