Provider Demographics
NPI:1932608825
Name:GIDEON, ALYSSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GIDEON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1236
Mailing Address - Country:US
Mailing Address - Phone:765-592-5884
Mailing Address - Fax:
Practice Address - Street 1:905 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1236
Practice Address - Country:US
Practice Address - Phone:765-592-5884
Practice Address - Fax:765-592-5884
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006243A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist