Individual
ALYSSA IACONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15023 21 MILE RD, SHELBY TWP, MI 48315-5024
(586) 286-9644
Mailing address
15023 21 MILE RD, SHELBY TWP, MI 48315-5024
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101005826
—
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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