Healthcare Provider Details

I. General information

NPI: 1083868236
Provider Name (Legal Business Name): ALISSA MARIE IANTOSCA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BUCKLEY RD
WHITEHALL NY
12887-3633
US

IV. Provider business mailing address

6 GLEN CT
QUEENSBURY NY
12804-8496
US

V. Phone/Fax

Practice location:
  • Phone: 518-499-0330
  • Fax:
Mailing address:
  • Phone: 518-420-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016068-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: