Provider Demographics
NPI:1821307638
Name:ALESSI, ALICE (MS; CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:ALESSI
Suffix:
Gender:F
Credentials:MS; CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-1207
Mailing Address - Country:US
Mailing Address - Phone:716-358-2550
Mailing Address - Fax:
Practice Address - Street 1:13 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-1207
Practice Address - Country:US
Practice Address - Phone:716-358-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010056-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010056-1OtherNY LICENSE NUMBER