Provider Demographics
NPI:1912652041
Name:BLUNK, ALYSSA FAYE (CFY-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:FAYE
Last Name:BLUNK
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4208
Mailing Address - Country:US
Mailing Address - Phone:905-824-1478
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4208
Practice Address - Country:US
Practice Address - Phone:905-824-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist