Provider Demographics
NPI:1861525784
Name:HERBON, ALISSA LYNN (CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:LYNN
Last Name:HERBON
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 1:240 SADDLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9575
Mailing Address - Country:US
Mailing Address - Phone:317-536-5426
Mailing Address - Fax:
Practice Address - Street 1:240 SADDLEBROOK CT
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9575
Practice Address - Country:US
Practice Address - Phone:317-536-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003833A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist