Provider Demographics
NPI:1356595607
Name:HATTEM, ALYSSA MAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MAE
Last Name:HATTEM
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 1:460 E 79TH ST
Mailing Address - Street 2:APT 15F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1443
Mailing Address - Country:US
Mailing Address - Phone:212-861-8710
Mailing Address - Fax:
Practice Address - Street 1:460 E 79TH ST
Practice Address - Street 2:APT 15F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1443
Practice Address - Country:US
Practice Address - Phone:212-861-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015453- 1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist