Provider Demographics
NPI:1073236808
Name:SIMENTAL, ALYSSA ANN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:SIMENTAL
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 1:8107 S 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-3554
Mailing Address - Country:US
Mailing Address - Phone:402-969-6633
Mailing Address - Fax:
Practice Address - Street 1:8922 CUMING ST # 1N
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2732
Practice Address - Country:US
Practice Address - Phone:402-926-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician