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General NPI Number Information
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NPI Number | 1366093577
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Entity Type | Individual
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Provider Name | ALYSSA ADELINE MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 09/28/2019
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Last Update Date | 09/28/2019
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Provider Practice Location Address
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Address Line | 6330 NW KELLY DR STE A
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City | PARKVILLE
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State | MO
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Zip | 64152-4027
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Country | US
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Telephone | 816-569-5162
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Fax |
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Provider Business Mailing Address
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Address Line | 28200 SNIPE RD
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City | RICHLAND
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State | MO
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Zip | 65556-7455
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Country | US
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Telephone | 708-897-5438
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 19-87077
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License Number State | IL
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