MEDICARE: ALYSSA MARIA PROHASKI LMSW

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	101YM0800X	Mental Health Counselor	ASW30669	CA
2	104100000X	Social Worker	007222	IA

General Provider Information

NPI Number	:	1659525160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIA PROHASKI LMSW

Provider Business Mailing Address
First Line	:	5617 ROCHELLE DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50701-9562
Country	:	US
Telephone Number	:	319-290-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 MOBILE ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50703-3238
Country	:	US
Telephone Number	:	319-290-6001
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	07/05/2016

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