Healthcare Provider Details

I. General information

NPI: 1023653219
Provider Name (Legal Business Name): ALLYSON MARY VACCARO-PELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6993 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

6993 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-7924
  • Fax:
Mailing address:
  • Phone: 253-968-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60988173
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: