Individual
MRS. ALYSSA MARTIN HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
340 E JACKSON ST, GATE CITY, VA 24251-3526
(276) 386-6118
Mailing address
340 E JACKSON ST, GATE CITY, VA 24251-3526
(276) 386-6118
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008308
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2202008308
—
VA
Enumeration date
01/15/2018
Last updated
03/17/2018
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