Provider Demographics
NPI:1275165177
Name:MATTSON, ALISON JOY (L AC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JOY
Last Name:MATTSON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MILL LOFT ST UNIT D-118
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7922
Mailing Address - Country:US
Mailing Address - Phone:970-620-0191
Mailing Address - Fax:
Practice Address - Street 1:113 MILL LOFT ST UNIT D-118
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7922
Practice Address - Country:US
Practice Address - Phone:970-620-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU-1741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist