Provider Demographics
NPI:1649662727
Name:ROSCIA, ALYSEN (MS,CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:ALYSEN
Middle Name:
Last Name:ROSCIA
Suffix:
Gender:F
Credentials:MS,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3032
Mailing Address - Country:US
Mailing Address - Phone:814-931-7685
Mailing Address - Fax:
Practice Address - Street 1:951 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1426
Practice Address - Country:US
Practice Address - Phone:814-684-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14046790OtherASHA
PASL011494OtherLICENSE