Provider Demographics
NPI:1164299020
Name:VIEAU, ALISSA ANN
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANN
Last Name:VIEAU
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 1:99 POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:PELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49769-9303
Mailing Address - Country:US
Mailing Address - Phone:231-818-2997
Mailing Address - Fax:
Practice Address - Street 1:99 POPLAR RD
Practice Address - Street 2:
Practice Address - City:PELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49769-9303
Practice Address - Country:US
Practice Address - Phone:231-818-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician