Provider Demographics
NPI:1194210583
Name:ECKENRODE, ALYSSA ANN (LSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:ECKENRODE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 SAINT FRANCIS LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-7321
Mailing Address - Country:US
Mailing Address - Phone:814-932-6070
Mailing Address - Fax:
Practice Address - Street 1:1906 N JUNIATA ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648
Practice Address - Country:US
Practice Address - Phone:814-695-2984
Practice Address - Fax:814-695-2110
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker