Provider Demographics
NPI:1881290955
Name:HOWARD, ALYSSA RICHIELLE (MHS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RICHIELLE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-2310
Mailing Address - Country:US
Mailing Address - Phone:815-207-9758
Mailing Address - Fax:
Practice Address - Street 1:200 E COURT ST STE 708
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3845
Practice Address - Country:US
Practice Address - Phone:815-304-5548
Practice Address - Fax:815-304-5723
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist