Provider Demographics
NPI:1306085980
Name:LEARY, ALYSSA MARIE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:LEARY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SE 124TH AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6015
Mailing Address - Country:US
Mailing Address - Phone:503-449-4138
Mailing Address - Fax:
Practice Address - Street 1:108 SE 124TH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6015
Practice Address - Country:US
Practice Address - Phone:503-449-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60074053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist