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General NPI Number Information
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NPI Number | 1265665426
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Entity Type | Individual
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Provider Name | ALYSSA LIANA ESTORNELL M.S.,CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 2963 WERWOOD CT
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City | WELLINGTON
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State | FL
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Zip | 33414-7680
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Country | US
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Telephone | 561-635-7798
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Fax |
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Provider Business Mailing Address
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Address Line | 311 LYTLE ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4619
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Country | US
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Telephone | 561-588-5162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA5328
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License Number State | FL
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