Basic Information
Provider Information
NPI: 1003000191
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELTMAN
FirstName: ALYSSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 113 HILLCREST DRE
Address2:  
City: SANFORD
State: NC
PostalCode: 273304020
CountryCode: US
TelephoneNumber: 9197770240
FaxNumber:  
Practice Location
Address1: 113 HILLCREST DRE
Address2:  
City: SANFORD
State: NC
PostalCode: 273304020
CountryCode: US
TelephoneNumber: 9197770240
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/31/2007
LastUpdateDate: 08/31/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X1NCY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home