Provider Demographics
NPI:1790323145
Name:TERSIGNI-TACKETT, ALYSSA (SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TERSIGNI-TACKETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:TERSIGNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:6433 S RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-8378
Mailing Address - Country:US
Mailing Address - Phone:440-474-3781
Mailing Address - Fax:
Practice Address - Street 1:2630 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2405
Practice Address - Country:US
Practice Address - Phone:440-576-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20191265-SP235Z00000X
OHSP.14590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty