Provider Demographics
NPI:1992546170
Name:BOYER, ALYSSA ROSE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:BOYER
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 1:6038 W CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2102
Mailing Address - Country:US
Mailing Address - Phone:262-957-6530
Mailing Address - Fax:
Practice Address - Street 1:8901 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1706
Practice Address - Country:US
Practice Address - Phone:414-465-5770
Practice Address - Fax:414-260-8980
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7887-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional