Provider Demographics
NPI:1790258838
Name:HOEPPNER, ALYSSA ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:ELIZABETH
Last Name:HOEPPNER
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 1:3726 QUEEN CT SW STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-3903
Mailing Address - Country:US
Mailing Address - Phone:319-361-6529
Mailing Address - Fax:319-343-1059
Practice Address - Street 1:1061 COURT AVE
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1439
Practice Address - Country:US
Practice Address - Phone:319-642-3031
Practice Address - Fax:319-343-1059
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101342Medicaid