Provider Demographics
NPI:1790801538
Name:DELORME, ALISON MATTOS (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MATTOS
Last Name:DELORME
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:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0629
Mailing Address - Country:US
Mailing Address - Phone:919-440-5786
Mailing Address - Fax:919-573-0759
Practice Address - Street 1:804 SARAZEN DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-3921
Practice Address - Country:US
Practice Address - Phone:919-440-5786
Practice Address - Fax:919-573-0759
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412211Medicaid
NC138F6OtherBCBS