Provider Demographics
NPI:1003692815
Name:HARRISON, ALESSIA TAYLOR
Entity Type:Individual
Prefix:
First Name:ALESSIA
Middle Name:TAYLOR
Last Name:HARRISON
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 1:1343 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-1642
Mailing Address - Country:US
Mailing Address - Phone:224-645-5589
Mailing Address - Fax:
Practice Address - Street 1:1343 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-1642
Practice Address - Country:US
Practice Address - Phone:224-645-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer