Healthcare Provider Details

I. General information

NPI: 1396820338
Provider Name (Legal Business Name): ALYSON WYSONG-HARDER M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CHERRY ST
NEVADA MO
64772-2202
US

IV. Provider business mailing address

300 W CHERRY ST
NEVADA MO
64772-2202
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-4230
  • Fax: 417-667-7607
Mailing address:
  • Phone: 417-667-4230
  • Fax: 417-667-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2003032191
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: