Provider Demographics
NPI:1568202786
Name:BANNISTER, ALYSSA LYNN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:BANNISTER
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 1:166 SMITHRIDGE PARK
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5729
Mailing Address - Country:US
Mailing Address - Phone:775-815-9015
Mailing Address - Fax:
Practice Address - Street 1:3685 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5280
Practice Address - Country:US
Practice Address - Phone:775-360-3206
Practice Address - Fax:775-490-3001
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist