Provider Demographics
NPI:1689415291
Name:SOUTHWICK, ALYSSA (SLPA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SOUTHWICK
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 HAYDEN PKWY APT 713
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9190
Mailing Address - Country:US
Mailing Address - Phone:916-295-2349
Mailing Address - Fax:
Practice Address - Street 1:919 RESERVE DR STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1346
Practice Address - Country:US
Practice Address - Phone:916-237-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant