Provider Demographics
NPI:1760614390
Name:REDDING, ALISSA JOY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:JOY
Last Name:REDDING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-2276
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:417 FRANKLIN ST S
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1598
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:320-334-3249
Is Sole Proprietor?:No
Enumeration Date:2009-08-15
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN880213EP1101X
MI5901002286213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery