Provider Demographics
NPI:1811136864
Name:POWERS, ALICE G (MSP CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:G
Last Name:POWERS
Suffix:
Gender:F
Credentials:MSP CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 STAMPER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4375
Mailing Address - Country:US
Mailing Address - Phone:910-488-2894
Mailing Address - Fax:910-488-3861
Practice Address - Street 1:806 STAMPER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4375
Practice Address - Country:US
Practice Address - Phone:910-488-2894
Practice Address - Fax:910-488-3861
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist