Provider Demographics
NPI:1245463439
Name:NEIDLINGER, ALYCIA DAE (BC-HIS)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:DAE
Last Name:NEIDLINGER
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 5TH ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2417
Mailing Address - Country:US
Mailing Address - Phone:909-790-7762
Mailing Address - Fax:909-790-7772
Practice Address - Street 1:12139 5TH ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2417
Practice Address - Country:US
Practice Address - Phone:909-790-7762
Practice Address - Fax:909-790-7772
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3044237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist