Healthcare Provider Details

I. General information

NPI: 1114858453
Provider Name (Legal Business Name): ALYSSA MARIE TUCKER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 COMMERCIAL CENTER DR APT 1-A
LADSON SC
29456-4146
US

IV. Provider business mailing address

8711 YEARLING DR APT 1A
CHARLESTON SC
29406-9096
US

V. Phone/Fax

Practice location:
  • Phone: 618-972-0427
  • Fax:
Mailing address:
  • Phone: 618-972-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: