Provider Demographics
NPI:1861816001
Name:ROY, ANNALISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNALISA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:ANNALISA
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 BOALCH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7994
Mailing Address - Country:US
Mailing Address - Phone:425-888-2777
Mailing Address - Fax:425-888-3348
Practice Address - Street 1:209 MAIN AVE S STE 111
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8139
Practice Address - Country:US
Practice Address - Phone:425-888-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60431524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist