Doctor Name: | ALYSSA WRIGHT |
NPI Number: | 1003284753 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 150.01483 |
Business Practice Address: | 309 W Clark St Champaign, IL - 618204637 |
Business Phone Number: | 2173989066 |
Business Fax Number: | 2173989077 |
Mailing Address: | 309 W Clark St, CHAMPAIGN |
State: | IL |
Postal Code: | 618204637 |
Phone Number: | 2173989066 |
Fax Number: | 2173989077 |
NPI Enumeration Date: | 09/11/2015 |
NPI Last Update Date: | 09/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 150.01483 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |