Provider Demographics
NPI:1740719475
Name:DONNELLY, ALYSSA ANNE ROWEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANNE ROWEN
Last Name:DONNELLY
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 1:29 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1163
Mailing Address - Country:US
Mailing Address - Phone:973-800-8526
Mailing Address - Fax:
Practice Address - Street 1:29 BURNHAM DR
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1163
Practice Address - Country:US
Practice Address - Phone:973-800-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00856100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist