Healthcare Provider Details

I. General information

NPI: 1619668308
Provider Name (Legal Business Name): ALISSA LEE DEMKE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 46TH AVE SE STE 201
MANDAN ND
58554-4829
US

IV. Provider business mailing address

2401 46TH AVE SE STE 201
MANDAN ND
58554-4829
US

V. Phone/Fax

Practice location:
  • Phone: 701-699-4052
  • Fax: 701-989-7030
Mailing address:
  • Phone: 701-699-4052
  • Fax: 701-989-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6369
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: