Provider Demographics
NPI:1285185736
Name:HENNINGS, ALYSSA (MA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HENNINGS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5796
Mailing Address - Country:US
Mailing Address - Phone:563-542-9349
Mailing Address - Fax:866-496-4073
Practice Address - Street 1:1766 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3607
Practice Address - Country:US
Practice Address - Phone:563-542-9349
Practice Address - Fax:866-496-4073
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health