Alyssa Selembo Pollack, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

30002641 Issued in NC

Practice address

13739 Steele Creek Rd Unit 103
Charlotte, NC 28273-7139

Phone

(704) 931-3628

NPI assigned

May 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Taylor Alyssa Selembo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeastern Communication and Swallowing Specialists

  • Speech-Language Pathologist
  • Fayetteville, NC
  • NPI 1841662954
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1376390336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 BRENT HALL CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282709745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13739 STEELE CREEK RD UNIT 103",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282737139",
            "telephone_number": "704-931-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLACK",
        "first_name": "ALYSSA",
        "middle_name": "SELEMBO",
        "name_prefix": "Mrs.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "30002641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "SELEMBO",
            "middle_name": "ALYSSA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Gracyn Polk, DPT
• Candice Polk
• Christopher Michael Polk, MD
• Edwina Denise Polk, LPC
• Inobeme Polk, LCSW-A
• Ava Pollack, LCMHC
• Joshua David Pollack, DDS
• Leanna Pollack
• Rebecca Ida Pollack, MD
• Anne Marie Pollard

• Speech-Language Pathologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.