Provider Demographics
NPI:1740728856
Name:TIMINSKI, ALYSSA (MSCCCSLP)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:TIMINSKI
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WYOMING RD
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-8906
Mailing Address - Country:US
Mailing Address - Phone:606-674-6613
Mailing Address - Fax:
Practice Address - Street 1:406 WYOMING RD
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8906
Practice Address - Country:US
Practice Address - Phone:606-674-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist