Healthcare Provider Details

I. General information

NPI: 1710700372
Provider Name (Legal Business Name): ALYSSA DYKE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 LEVIN RD NW STE 100
SILVERDALE WA
98383-8132
US

IV. Provider business mailing address

370 GROW AVE NW APT B2
BAINBRIDGE ISLAND WA
98110-1753
US

V. Phone/Fax

Practice location:
  • Phone: 360-698-5883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61575383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: