MEDICARE: DR. ALISA Y PREWITT SLPD-CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	100951	TX
2	235Z00000X	Speech-Language Pathologist	21346	CA

General Provider Information

NPI Number	:	1164458568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA Y PREWITT SLPD-CCC/SLP

Provider Business Mailing Address
First Line	:	21241 VENTURA BLVD STE 295
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2128
Country	:	US
Telephone Number	:	323-924-9464
Fax Number	:	281-392-8239

Provider Business Practice Location Address
First Line	:	21241 VENTURA BLVD STE 295
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2128
Country	:	US
Telephone Number	:	323-924-9464
Fax Number	:	281-392-8239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/14/2024

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