Provider Demographics
NPI:1144072554
Name:PIERCE, ALISSA (SLP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:KETCHERSIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7231 BOULDER AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3313
Mailing Address - Country:US
Mailing Address - Phone:909-648-5525
Mailing Address - Fax:
Practice Address - Street 1:4989 HUNTSMEN PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0613
Practice Address - Country:US
Practice Address - Phone:909-913-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist