Provider Demographics
NPI:1780474197
Name:PARKER, ALISSA DIANE (SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:DIANE
Last Name:PARKER
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 BRENT AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2725
Mailing Address - Country:US
Mailing Address - Phone:317-650-1106
Mailing Address - Fax:
Practice Address - Street 1:6370 ROBIN RUN W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4051
Practice Address - Country:US
Practice Address - Phone:317-650-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002817A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist