Individual
AILISSA ALSUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
205 PLAZA BLVD., CABOT, AR 72023
(501) 628-0063
(501) 676-0066
Mailing address
P.O. BOX 980, LONOKE, AR 72086
(501) 676-2786
(501) 676-0697
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#1218
AR
Other
Enumeration date
09/19/2006
Last updated
07/09/2007
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