Provider Demographics
NPI:1285981977
Name:ALSTON, DMETRIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DMETRIA
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 ZACH CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5013
Mailing Address - Country:US
Mailing Address - Phone:614-546-6828
Mailing Address - Fax:614-635-2699
Practice Address - Street 1:3126 ZACH CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-5013
Practice Address - Country:US
Practice Address - Phone:614-546-6828
Practice Address - Fax:614-635-2699
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist