Healthcare Provider Details

I. General information

NPI: 1699690222
Provider Name (Legal Business Name): ALYSSA ANNE MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALYSSA ANNE AMESCUA

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 S CALIFORNIA AVE
CHICAGO IL
60612
US

IV. Provider business mailing address

9271 HAYES ST APT 108
MERRILLVILLE IN
46410-6868
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-5750
  • Fax:
Mailing address:
  • Phone: 708-983-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: