Healthcare Provider Details

I. General information

NPI: 1467144824
Provider Name (Legal Business Name): ALYSSA ZILZ MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA FROMAN

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 HOHMAN AVE
HAMMOND IN
46320-1809
US

IV. Provider business mailing address

5311 HOHMAN AVE
HAMMOND IN
46320-1809
US

V. Phone/Fax

Practice location:
  • Phone: 219-973-7733
  • Fax:
Mailing address:
  • Phone: 219-973-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33009169A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: