Provider Demographics
NPI:1669702395
Name:NIXON, ALISSA (SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/S
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 7535
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-816-7201
Mailing Address - Fax:
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-816-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist