Healthcare Provider Details

I. General information

NPI: 1447644224
Provider Name (Legal Business Name): ALISSA EISCHENS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BROADWAY AVE
ST PAUL PARK MN
55071-1554
US

IV. Provider business mailing address

1621 UPPER AFTON RD APT A
SAINT PAUL MN
55106-6857
US

V. Phone/Fax

Practice location:
  • Phone: 952-500-3830
  • Fax: 866-450-3814
Mailing address:
  • Phone: 312-498-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24118
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: