Provider Demographics
NPI:1396820338
Name:WYSONG-HARDER, ALYSON (MSW)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:WYSONG-HARDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2202
Mailing Address - Country:US
Mailing Address - Phone:417-667-4230
Mailing Address - Fax:417-667-7607
Practice Address - Street 1:300 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2202
Practice Address - Country:US
Practice Address - Phone:417-667-4230
Practice Address - Fax:417-667-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030321911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498981612Medicaid