Provider Demographics
NPI:1053730846
Name:MCDONOUGH-UTLEY, ALYSSIA
Entity type:Individual
Prefix:MRS
First Name:ALYSSIA
Middle Name:
Last Name:MCDONOUGH-UTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1657
Mailing Address - Country:US
Mailing Address - Phone:734-487-2890
Mailing Address - Fax:734-485-2892
Practice Address - Street 1:1055 CORNELL RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1657
Practice Address - Country:US
Practice Address - Phone:734-487-2890
Practice Address - Fax:734-485-2892
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist