Provider Demographics
NPI:1124771779
Name:THOZESKI, ALISSA ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANN
Last Name:THOZESKI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 LAKE ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1043
Mailing Address - Country:US
Mailing Address - Phone:708-763-9582
Mailing Address - Fax:
Practice Address - Street 1:1144 LAKE ST STE 200B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1043
Practice Address - Country:US
Practice Address - Phone:708-763-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146.017008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist