Individual
ALISSA L WAUGHTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5990 IVORY DR, FARMINGTON, NY 14425-9073
(315) 882-4490
Mailing address
5990 IVORY DR, FARMINGTON, NY 14425-9073
(315) 882-4490
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
023460-1
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/07/2013
Last updated
08/15/2024
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