Provider Demographics
NPI:1588293930
Name:WICHROSKI, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:WICHROSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROLLER COASTER RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03884-6648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 ROLLER COASTER RD
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:NH
Practice Address - Zip Code:03884-6648
Practice Address - Country:US
Practice Address - Phone:603-664-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH09128055235Z00000X
NH0837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist