Provider Demographics
NPI:1780836221
Name:MALDONADO, ALYSON MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:MALDONADO
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 1:5401 BAYCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4201
Mailing Address - Country:US
Mailing Address - Phone:727-432-0295
Mailing Address - Fax:
Practice Address - Street 1:7001A LOISDALE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1904
Practice Address - Country:US
Practice Address - Phone:703-971-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009344235Z00000X
FLSA10389235Z00000X
MD06415235Z00000X
VA2202006336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist