Provider Demographics
NPI:1023460698
Name:BOSWORTH, ALYSSA GIACALONE (MS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GIACALONE
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S LODGE LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2918
Mailing Address - Country:US
Mailing Address - Phone:312-208-4556
Mailing Address - Fax:
Practice Address - Street 1:412 MEADOWLARK RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1332
Practice Address - Country:US
Practice Address - Phone:312-208-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist