Provider Demographics
NPI:1023714078
Name:GIBSON, ALYSSA BETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BETH
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SW STREMLER DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7175
Mailing Address - Country:US
Mailing Address - Phone:781-264-5163
Mailing Address - Fax:
Practice Address - Street 1:350 S OAK HARBOR ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5137
Practice Address - Country:US
Practice Address - Phone:360-279-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14263554OtherASHA
WALL61230242OtherWA STATE SLP LICENSE