Provider Demographics
NPI:1699898833
Name:GARCIA, ALYSEN (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSEN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:ALYSEN
Other - Middle Name:
Other - Last Name:MCELVEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:12648 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9316
Mailing Address - Country:US
Mailing Address - Phone:850-339-5162
Mailing Address - Fax:
Practice Address - Street 1:9040 EXECUTIVE PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4630
Practice Address - Country:US
Practice Address - Phone:865-693-5622
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist