Healthcare Provider Details

I. General information

NPI: 1548171077
Provider Name (Legal Business Name): ALYSSA GROGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14562 MANCHESTER AVE
CHINO CA
91710-6968
US

IV. Provider business mailing address

1500 S HAVEN AVE STE 190
ONTARIO CA
91761-2971
US

V. Phone/Fax

Practice location:
  • Phone: 909-479-4020
  • Fax:
Mailing address:
  • Phone: 909-390-1313
  • Fax: 909-390-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: