Provider Demographics
NPI:1447634472
Name:WEISS, ALLYSON D (AUD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:D
Last Name:WEISS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:D
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 E CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6202
Mailing Address - Country:US
Mailing Address - Phone:815-455-0850
Mailing Address - Fax:815-455-1067
Practice Address - Street 1:390 E CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6202
Practice Address - Country:US
Practice Address - Phone:815-455-0850
Practice Address - Fax:815-455-1067
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
IL147-001550231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist