Provider Demographics
NPI:1306242532
Name:PITTS, ALYSSA ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANN
Last Name:PITTS
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 1:13211 E SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-8020
Mailing Address - Country:US
Mailing Address - Phone:479-790-0249
Mailing Address - Fax:
Practice Address - Street 1:2317 N MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-7070
Practice Address - Country:US
Practice Address - Phone:479-755-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200578350AMedicaid
AR206687721Medicaid