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General NPI Number Information
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NPI Number | 1487468633
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Entity Type | Individual
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Provider Name | ALYSSA WENNING
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 700 BOARDMAN DR
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City | GALLUP
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State | NM
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Zip | 87301-4707
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Country | US
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Telephone | 505-721-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1318
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City | GALLUP
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State | NM
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Zip | 87305-1318
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Country | US
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Telephone |
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | SWB-2023-0798
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License Number State | NM
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