Provider Demographics
NPI:1912381138
Name:HENCLEY, ALYSSA (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:
Last Name:HENCLEY
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 1:15200 18TH AVE N
Mailing Address - Street 2:APT 12
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2418
Mailing Address - Country:US
Mailing Address - Phone:651-280-5751
Mailing Address - Fax:
Practice Address - Street 1:15200 18TH AVE N
Practice Address - Street 2:APT 12
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-2418
Practice Address - Country:US
Practice Address - Phone:651-280-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist