Provider Demographics
NPI:1073009510
Name:EBENHOCH, ALYSA CHRISTINE (MSED, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALYSA
Middle Name:CHRISTINE
Last Name:EBENHOCH
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 12TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1739
Mailing Address - Country:US
Mailing Address - Phone:518-253-5740
Mailing Address - Fax:
Practice Address - Street 1:2566 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1002
Practice Address - Country:US
Practice Address - Phone:518-377-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028843235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist