Individual
ALYSSA NICOLE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CFY
Contact information
Practice address
4027 N BROADWAY ST APT 304, CHICAGO, IL 60613-2299
(951) 551-3212
Mailing address
4027 N BROADWAY ST APT 304, CHICAGO, IL 60613-2299
(951) 551-3212
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242.005411
IL
235Z00000X
Speech-Language Pathologist
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Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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