Provider Demographics
NPI:1720596760
Name:ROME, ALYSSA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ROME
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2546
Mailing Address - Country:US
Mailing Address - Phone:510-604-7325
Mailing Address - Fax:
Practice Address - Street 1:1614 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94707-2546
Practice Address - Country:US
Practice Address - Phone:510-214-3885
Practice Address - Fax:510-768-8665
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11892235Z00000X
CA27438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY