1538567839 NPI number — ALYSSA FLEMING MA, CCC-SLP

Table of content: ALYSSA FLEMING MA, CCC-SLP (NPI 1538567839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538567839 NPI number — ALYSSA FLEMING MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
ALYSSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538567839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99122-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-818-0208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28000 PRAIRIE SPRINGS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-818-0208
Provider Business Practice Location Address Fax Number:
509-351-3532
Provider Enumeration Date:
12/18/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP-3372 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLPI.SI.60485003 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 60485007 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2049616 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".