Provider Demographics
NPI:1285477505
Name:BOZYM, ALYSSA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BOZYM
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 1:4507 SEQUOIA DR APT C208
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-6404
Mailing Address - Country:US
Mailing Address - Phone:570-994-5560
Mailing Address - Fax:
Practice Address - Street 1:419 VILLAGE DR STE B
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6943
Practice Address - Country:US
Practice Address - Phone:717-446-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist