Provider Demographics
NPI:1104463959
Name:DEWBERRY, ALYSSA NOELLE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NOELLE
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 LAKE PARK DR SE APT M
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7660
Mailing Address - Country:US
Mailing Address - Phone:678-523-7206
Mailing Address - Fax:
Practice Address - Street 1:3650 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:678-305-9200
Practice Address - Fax:678-305-9201
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist