Provider Demographics
NPI:1750705596
Name:SUJEEBUN, ALYSON (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:
Last Name:SUJEEBUN
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 1:3805 MARLANE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9224
Mailing Address - Country:US
Mailing Address - Phone:614-801-3000
Mailing Address - Fax:
Practice Address - Street 1:255 WESTWOODS BLVD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8548
Practice Address - Country:US
Practice Address - Phone:614-801-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist