Provider Demographics
NPI:1821736737
Name:DAVIS, ALYSSA LEBLANC (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEBLANC
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 KENSINGTON LAKES DR UNIT 903
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7167
Mailing Address - Country:US
Mailing Address - Phone:904-651-3805
Mailing Address - Fax:
Practice Address - Street 1:5150 PALM VALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4630
Practice Address - Country:US
Practice Address - Phone:904-616-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist