Provider Demographics
NPI:1033455217
Name:NOONAN, ALYSSA BROOKE-WALTON (LLMSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BROOKE-WALTON
Last Name:NOONAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:BROOKE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2615 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1654
Mailing Address - Country:US
Mailing Address - Phone:269-343-1651
Mailing Address - Fax:269-382-7078
Practice Address - Street 1:2615 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1654
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:269-382-7078
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical