Provider Demographics
NPI:1306878681
Name:MENDOZA, ALISA JUDITH (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JUDITH
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37406 PROVENCE POINTE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4397
Mailing Address - Country:US
Mailing Address - Phone:225-677-9402
Mailing Address - Fax:225-744-4939
Practice Address - Street 1:37406 PROVENCE POINTE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4397
Practice Address - Country:US
Practice Address - Phone:225-677-9402
Practice Address - Fax:225-744-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist