Provider Demographics
NPI:1063923282
Name:ACKETT, ALYSSA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ACKETT
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 1:8340 GREENSBORO DR UNIT 704
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3545
Mailing Address - Country:US
Mailing Address - Phone:352-949-3435
Mailing Address - Fax:
Practice Address - Street 1:11908 BRISTOL MANOR CT
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-5804
Practice Address - Country:US
Practice Address - Phone:301-881-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist