Healthcare Provider Details

I. General information

NPI: 1508582685
Provider Name (Legal Business Name): ALYSSA M BOLANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

IV. Provider business mailing address

3640 COLONEL GLENN HWY, 117 HEALTH SCIENCE BLDG.
DAYTON OH
45435
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-9067
  • Fax:
Mailing address:
  • Phone: 937-775-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: