Provider Demographics
NPI:1437043775
Name:CAVAZOS, ALYSSA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2977 ENSALMO WAY
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0733
Mailing Address - Country:US
Mailing Address - Phone:702-606-0714
Mailing Address - Fax:
Practice Address - Street 1:2020 SILVER CREEK RD STE D102
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8484
Practice Address - Country:US
Practice Address - Phone:702-606-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP16238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist