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General NPI Number Information
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NPI Number | 1346149994
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Entity Type | Individual
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Provider Name | ALLYSSA A GORDON LPCIT
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Gender | Female
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 36745 AIKEN RD
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City | BAYFIELD
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State | WI
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Zip | 54814-4579
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Country | US
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Telephone | 715-779-3707
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Fax | 715-779-3362
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Provider Business Mailing Address
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Address Line | 1209 1/2 N 16TH ST
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City | SUPERIOR
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State | WI
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Zip | 54880-2828
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Country | US
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Telephone | 715-779-3707
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Fax | 715-779-3362
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5198-226
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License Number State | WI
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