Provider Demographics
NPI:1609461623
Name:HUGHES, ALLISSA MARIE
Entity Type:Individual
Prefix:
First Name:ALLISSA
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-4757
Mailing Address - Country:US
Mailing Address - Phone:816-945-2708
Mailing Address - Fax:
Practice Address - Street 1:4025 NE LAKEWOOD WAY STE 100
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2058
Practice Address - Country:US
Practice Address - Phone:816-598-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013003225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist