Healthcare Provider Details

I. General information

NPI: 1073026233
Provider Name (Legal Business Name): ALYSSA DANIELLE SHEARER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA DANIELLE BENNETT

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N SULLIVAN RD STE F 139
SPOKANE VALLEY WA
99037-8543
US

IV. Provider business mailing address

1641 S TURNAGIN PL
MOSES LAKE WA
98837-2420
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 509-771-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61068406
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: