Provider Demographics
NPI:1699349282
Name:VANNATTA, ALAYNA MARY
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:MARY
Last Name:VANNATTA
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 1:19077 KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9734
Mailing Address - Country:US
Mailing Address - Phone:419-377-3302
Mailing Address - Fax:
Practice Address - Street 1:5726 SOUTHWYCK BLVD STE 115
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1510
Practice Address - Country:US
Practice Address - Phone:419-708-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUU517897OtherDRIVERS LICENSE