Provider Demographics
NPI:1548621253
Name:BUCCELLATO, ALISON L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:L
Last Name:BUCCELLATO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MAYNARD GRAYSON RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-9491
Mailing Address - Country:US
Mailing Address - Phone:803-810-8837
Mailing Address - Fax:
Practice Address - Street 1:337 MAYNARD GRAYSON RD
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-9491
Practice Address - Country:US
Practice Address - Phone:803-810-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3640214235Z00000X
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist