MEDICARE: ALYSSA FULTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150118870	IL

General Provider Information

NPI Number	:	1609695733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA FULTON

Provider Business Mailing Address
First Line	:	100 MALTON RD
Second Line	:
City	:	NEGAUNEE
State	:	MI
Zip	:	49866-2001
Country	:	US
Telephone Number	:	906-228-9699
Fax Number	:

Provider Business Practice Location Address
First Line	:	5465 GRAND AVE STE 101
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-4913
Country	:	US
Telephone Number	:	224-303-4395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	01/05/2026

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Directions to “ ALYSSA FULTON ” Practice Location

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