Provider Demographics
NPI:1902165061
Name:ALISA MCCLOUD
Entity Type:Organization
Organization Name:ALISA MCCLOUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGAUGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:828-230-5464
Mailing Address - Street 1:32 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3222
Mailing Address - Country:US
Mailing Address - Phone:828-230-5464
Mailing Address - Fax:828-225-2761
Practice Address - Street 1:32 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3222
Practice Address - Country:US
Practice Address - Phone:828-230-5464
Practice Address - Fax:828-225-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3675235Z00000X
NC465251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty