Provider Demographics
NPI:1790305969
Name:GILMAN, ALYSSA B (MS SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:B
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-6325
Mailing Address - Country:US
Mailing Address - Phone:409-877-1091
Mailing Address - Fax:
Practice Address - Street 1:807 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-6325
Practice Address - Country:US
Practice Address - Phone:409-877-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX115717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist