MEDICARE: DMETRIA ALSTON MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.6414	OH

General Provider Information

NPI Number	:	1285981977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DMETRIA ALSTON MA, CCC-SLP

Provider Business Mailing Address
First Line	:	3126 ZACH CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-5013
Country	:	US
Telephone Number	:	614-546-6828
Fax Number	:	614-635-2699

Provider Business Practice Location Address
First Line	:	3126 ZACH CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-5013
Country	:	US
Telephone Number	:	614-546-6828
Fax Number	:	614-635-2699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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Directions to “ DMETRIA ALSTON MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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