Provider Demographics
NPI:1376695296
Name:IVEY, ANNALISA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:NICOLE
Last Name:IVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 COLONY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6257
Mailing Address - Country:US
Mailing Address - Phone:541-729-1972
Mailing Address - Fax:
Practice Address - Street 1:825 MONROE ST STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5176
Practice Address - Country:US
Practice Address - Phone:541-729-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR34701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical