Basic Information
| Provider Information | |||||||||
| NPI: | 1871984054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAAS | ||||||||
| FirstName: | ALYSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 705 | ||||||||
| Address2: | |||||||||
| City: | GOLDENS BRIDGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105260705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173999033 | ||||||||
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| Practice Location | |||||||||
| Address1: | ANDRUS ORCHARD SCHOOL | ||||||||
| Address2: | 1156 N. BROADWAY | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149653700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 009506-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.