Provider Demographics
NPI:1891107348
Name:FETTERMAN, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FETTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 WRIGHTSVILLE AVE
Mailing Address - Street 2:UNIT 20
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8441
Mailing Address - Country:US
Mailing Address - Phone:910-799-0303
Mailing Address - Fax:910-799-0303
Practice Address - Street 1:3807 WRIGHTSVILLE AVE
Practice Address - Street 2:UNIT 20
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8441
Practice Address - Country:US
Practice Address - Phone:910-799-0303
Practice Address - Fax:910-799-0303
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist