Healthcare Provider Details

I. General information

NPI: 1003669516
Provider Name (Legal Business Name): ALYSSA EVERITT RD, MSW, LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4628 S GAZELLE ST
SEATTLE WA
98118-5636
US

IV. Provider business mailing address

4628 S GAZELLE ST
SEATTLE WA
98118-5636
US

V. Phone/Fax

Practice location:
  • Phone: 303-815-2314
  • Fax:
Mailing address:
  • Phone: 303-815-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number61506057
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: