MEDICARE: ALYCIA DUKES M.S., 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	16441	CA

General Provider Information

NPI Number	:	1447488291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYCIA DUKES M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	8002 CAMINO TRANQUILO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8002 CAMINO TRANQUILO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1730
Country	:	US
Telephone Number	:	801-372-9333
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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