Provider Demographics
NPI:1992752802
Name:CORLEY, ALICE RISLEY (MACCCSLP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:RISLEY
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:RISLEY
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:63 RAGAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2264
Mailing Address - Country:US
Mailing Address - Phone:318-487-2089
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:VAMC SPEECH CLINIC (126)
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-466-2815
Practice Address - Fax:318-483-5117
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist