Provider Demographics
NPI:1336418193
Name:FRIEDMAN, ALISSA RENEE (SLP, MS-CCC-L)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:RENEE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:SLP, MS-CCC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 ELM ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1414
Mailing Address - Country:US
Mailing Address - Phone:315-637-2855
Mailing Address - Fax:
Practice Address - Street 1:304 ELM ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1414
Practice Address - Country:US
Practice Address - Phone:315-637-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014534-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434959Medicaid