Provider Demographics
NPI:1295998904
Name:SIEGEL, ALYSSA BROOKE (SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BROOKE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 CURITIBA CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1454
Mailing Address - Country:US
Mailing Address - Phone:917-921-0449
Mailing Address - Fax:
Practice Address - Street 1:3470 CURITIBA CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1454
Practice Address - Country:US
Practice Address - Phone:917-921-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA642871014AMedicaid