Provider Demographics
NPI:1710585930
Name:JONES, ALYSSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:JONES
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 1:11549 YARD ST APT 313
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-0024
Mailing Address - Country:US
Mailing Address - Phone:317-537-7698
Mailing Address - Fax:
Practice Address - Street 1:11549 YARD ST APT 313
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-0024
Practice Address - Country:US
Practice Address - Phone:317-537-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007516A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist