Basic Information
| Provider Information | |||||||||
| NPI: | 1992752802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORLEY | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | RISLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA.CCC.SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OWENS | ||||||||
| OtherFirstName: | ALICE | ||||||||
| OtherMiddleName: | RISLEY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A.CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 63 RAGAN DR | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713032264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184872089 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2495 SHREVEPORT HWY | ||||||||
| Address2: | VAMC SPEECH CLINIC (126) | ||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184662815 | ||||||||
| FaxNumber: | 3184835117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1202 | LA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.