Provider Demographics
NPI:1457974461
Name:MARUSZCZAK, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MARUSZCZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 TYLER AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3819
Mailing Address - Country:US
Mailing Address - Phone:401-639-9089
Mailing Address - Fax:
Practice Address - Street 1:1009 OLD COUNTRY CLUB RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2927
Practice Address - Country:US
Practice Address - Phone:540-767-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist