Provider Demographics
NPI:1952832685
Name:CANOSA, ALYSSA MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:CANOSA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CREAMERY WAY
Mailing Address - Street 2:STE 103
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2533
Mailing Address - Country:US
Mailing Address - Phone:610-415-1100
Mailing Address - Fax:610-415-1101
Practice Address - Street 1:826 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4459
Practice Address - Country:US
Practice Address - Phone:610-415-1100
Practice Address - Fax:610-415-1101
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006485231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist