| NPI | 1932681327 |
|---|---|
| Former Name | ALYSSA VAN ETTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.014848) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2019-10-30 |