Provider Demographics
NPI:1104370998
Name:SCHMIDT, ALYSSA (QMHP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4709 44TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7187
Mailing Address - Country:US
Mailing Address - Phone:309-558-6605
Mailing Address - Fax:309-213-9438
Practice Address - Street 1:4709 44TH ST STE 5
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7187
Practice Address - Country:US
Practice Address - Phone:309-779-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5712537Medicaid