Provider Demographics
NPI:1265670764
Name:TOLL, ALYSON C (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:C
Last Name:TOLL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CHARMING ST
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4264
Mailing Address - Country:US
Mailing Address - Phone:407-718-2127
Mailing Address - Fax:
Practice Address - Street 1:1135 CHARMING ST
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4264
Practice Address - Country:US
Practice Address - Phone:407-718-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty