Provider Demographics
NPI:1306552096
Name:DEAKIN, ALYSSA ANN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:DEAKIN
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 1:42350 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2927
Mailing Address - Country:US
Mailing Address - Phone:586-552-9815
Mailing Address - Fax:
Practice Address - Street 1:42350 NIAGARA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2927
Practice Address - Country:US
Practice Address - Phone:586-552-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator