Provider Demographics
NPI:1760797476
Name:KAJKOWSKI, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:KAJKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-0040
Mailing Address - Country:US
Mailing Address - Phone:207-368-5146
Mailing Address - Fax:
Practice Address - Street 1:42 STETSON RD
Practice Address - Street 2:
Practice Address - City:CORINNA
Practice Address - State:ME
Practice Address - Zip Code:04928-3623
Practice Address - Country:US
Practice Address - Phone:207-278-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist