Healthcare Provider Details

I. General information

NPI: 1033524111
Provider Name (Legal Business Name): ALAYNA OBY SAC-IT, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD SUITE 200
BROWN DEER WI
53209-1220
US

IV. Provider business mailing address

4238 W HAWTHORNE TRACE RD APT 207
BROWN DEER WI
53209-1063
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 262-242-3816
Mailing address:
  • Phone: 414-793-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129436121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17001-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: