Provider Demographics
NPI:1215499918
Name:YODER, ALYSSA RAE
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:RAE
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PENN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3543
Mailing Address - Country:US
Mailing Address - Phone:610-373-4281
Mailing Address - Fax:
Practice Address - Street 1:645 PENN ST FL 2
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3543
Practice Address - Country:US
Practice Address - Phone:610-373-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232043478Medicaid