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NPI Code Detail

MEDICARE: ALYSSA OVERTON CCC-SLP

MEDICARE: ALYSSA OVERTON 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
1235Z00000XSpeech-Language PathologistSA 6899FL
2235Z00000XSpeech-Language Pathologist146.010610IL

General Provider Information

NPI Number : 1306134424
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA OVERTON CCC-SLP
Provider Business Mailing Address
First Line : 4559 BIRCHWOOD AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-6405
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4559 BIRCHWOOD AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-6405
Country : US
Telephone Number : 904-553-7826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2011
Last Update Date : 05/14/2016

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Directions to “ ALYSSA OVERTON CCC-SLP” Practice Location

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