Provider Demographics
NPI:1902853443
Name:MCCLOUD, ALISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:MCCLOUD
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 1:32 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3222
Mailing Address - Country:US
Mailing Address - Phone:828-230-5464
Mailing Address - Fax:828-225-2761
Practice Address - Street 1:32 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3222
Practice Address - Country:US
Practice Address - Phone:828-230-5464
Practice Address - Fax:828-225-2761
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1360HOtherBCBS PROVIDER NUMBER
NC7411736Medicaid