Provider Demographics
NPI:1295147460
Name:BODINE, ALYSSA Z
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:Z
Last Name:BODINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:ZONNEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 PALMYRA ST
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9329
Mailing Address - Country:US
Mailing Address - Phone:585-880-1053
Mailing Address - Fax:
Practice Address - Street 1:1490 STATE ROUTE 488
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9308
Practice Address - Country:US
Practice Address - Phone:585-880-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist