Alyssa Brooksher

Individual provider Active NPI Speech-Language Pathologist · Clermont, GA

NPI 1134858012 · NPPES record last updated Jun 6, 2023

Key facts

NPI
1134858012
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
PCET003568 (GA)
Practice address
130 Main St
Clermont, GA 30527-1804
Phone
(679) 616-3099
NPI assigned
Jun 7, 2022
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PCET003568GAMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist
Group: 193200000X MULTI-SPECIALTY GROUP
235Z00000X PCET003568 GA Yes

Addresses

Primary practice location

130 Main St
Clermont, GA 30527-1804

Mailing address

130 Main St
Clermont, GA 30527-1804

Other providers in Clermont, GA

All providers in Clermont, GA · Speech-Language Pathologist in Georgia

Sources for this page

Verify at the official NPI Registry.