Provider Demographics
NPI:1457785826
Name:GRIMES, ALYSSA LYNN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:LYNN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:LYNN
Other - Last Name:WATLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1 LADY SLIPPER TRL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-2130
Mailing Address - Country:US
Mailing Address - Phone:508-264-1028
Mailing Address - Fax:
Practice Address - Street 1:105 E GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2743
Practice Address - Country:US
Practice Address - Phone:508-947-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12156751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist