Healthcare Provider Details

I. General information

NPI: 1942154794
Provider Name (Legal Business Name): ALISSA BOSS ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLI BOSS ED.S.

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 4TH ST SW
FOREST LAKE MN
55025-1536
US

IV. Provider business mailing address

200 4TH ST SW
FOREST LAKE MN
55025-1536
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-3124
  • Fax:
Mailing address:
  • Phone: 651-982-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number496045
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: