Provider Demographics
NPI:1639835861
Name:FARLEY, ALLYSSA
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:
Last Name:FARLEY
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 1:11946 APPLEGROVE LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1502
Mailing Address - Country:US
Mailing Address - Phone:586-747-8397
Mailing Address - Fax:
Practice Address - Street 1:955 CAMPUS DR N
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2754
Practice Address - Country:US
Practice Address - Phone:248-475-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator