MEDICARE: ALYSON MARIE MALDONADO M.A. 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	146.009344	IL
2	235Z00000X	Speech-Language Pathologist	SA10389	FL
3	235Z00000X	Speech-Language Pathologist	06415	MD
4	235Z00000X	Speech-Language Pathologist	2202006336	VA

General Provider Information

NPI Number	:	1780836221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSON MARIE MALDONADO M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	5401 BAYCHESTER CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-4201
Country	:	US
Telephone Number	:	727-432-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001A LOISDALE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1904
Country	:	US
Telephone Number	:	703-971-0602
Fax Number	:

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/13/2015

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