Provider Demographics
NPI:1629523832
Name:BOWDEN, ALYSSA A
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:A
Other - Last Name:RIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0513
Mailing Address - Country:US
Mailing Address - Phone:907-373-1000
Mailing Address - Fax:888-588-5194
Practice Address - Street 1:500 E SWANSON AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7197
Practice Address - Country:US
Practice Address - Phone:907-373-1000
Practice Address - Fax:888-588-5194
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHCBMedicaid