Provider Demographics
NPI:1336867811
Name:VAN VOSSEN, ALYSSA ANNE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:ANNE
Last Name:VAN VOSSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17401 W LAKE HOUSTON PKWY APT 1205
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4997
Mailing Address - Country:US
Mailing Address - Phone:651-207-3911
Mailing Address - Fax:
Practice Address - Street 1:10203 BIRCHRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2200
Practice Address - Country:US
Practice Address - Phone:281-641-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist