Provider Demographics
NPI:1306512173
Name:BAJAN, ALYSHA RENEE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:RENEE
Last Name:BAJAN
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 1:6451 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4196
Mailing Address - Country:US
Mailing Address - Phone:440-255-7223
Mailing Address - Fax:
Practice Address - Street 1:6465 CURTISS CT
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2473
Practice Address - Country:US
Practice Address - Phone:440-255-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist