Provider Demographics
NPI:1629709217
Name:AOYAGI, ALYSSA (MHP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:AOYAGI
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-6746
Mailing Address - Country:US
Mailing Address - Phone:309-788-4571
Mailing Address - Fax:
Practice Address - Street 1:4230 11TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-6746
Practice Address - Country:US
Practice Address - Phone:309-788-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)