Individual
ALYSSA D. IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
307 COACHLIGHT DR, BENTONVILLE, AR 72712-5453
(479) 790-2137
Mailing address
307 COACHLIGHT DR, BENTONVILLE, AR 72712-5453
(479) 790-2137
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#2254
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y634
BLUE CROSS
AR
Enumeration date
07/05/2006
Last updated
02/25/2008
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