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General NPI Number Information
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NPI Number | 1659525160
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Entity Type | Individual
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Provider Name | ALYSSA MARIA PROHASKI LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 1112 MOBILE ST
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City | WATERLOO
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State | IA
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Zip | 50703-3238
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Country | US
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Telephone | 319-290-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 5617 ROCHELLE DR
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City | WATERLOO
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State | IA
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Zip | 50701-9562
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Country | US
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Telephone | 319-290-6001
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW30669
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 007222
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License Number State | IA
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