Healthcare Provider Details

I. General information

NPI: 1962891945
Provider Name (Legal Business Name): ALYSSA BOWYER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE
GLENDALE AZ
85304-1272
US

IV. Provider business mailing address

14033 N 39TH LN
PHOENIX AZ
85053-5463
US

V. Phone/Fax

Practice location:
  • Phone: 480-210-6445
  • Fax:
Mailing address:
  • Phone: 501-366-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP11193
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: