Healthcare Provider Details

I. General information

NPI: 1306242532
Provider Name (Legal Business Name): ALYSSA ANN PITTS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 N MOUNT OLIVE ST
SILOAM SPRINGS AR
72761-7070
US

IV. Provider business mailing address

13211 E SUGAR HILL RD
LINCOLN AR
72744-8020
US

V. Phone/Fax

Practice location:
  • Phone: 479-755-4047
  • Fax:
Mailing address:
  • Phone: 479-790-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4046
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: