Healthcare Provider Details

I. General information

NPI: 1356121909
Provider Name (Legal Business Name): ALYSSA VELLIQUETTE M.ED, BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 CENTRAL PARK W STE A
TOLEDO OH
43617-3011
US

IV. Provider business mailing address

3232 CENTRAL PARK W STE A
TOLEDO OH
43617-3011
US

V. Phone/Fax

Practice location:
  • Phone: 567-200-2262
  • Fax:
Mailing address:
  • Phone: 567-200-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2843935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: