Provider Demographics
NPI:1821875493
Name:LIST, ALISSA KATIA (BA, MA, CPC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:KATIA
Last Name:LIST
Suffix:
Gender:F
Credentials:BA, MA, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5010
Mailing Address - Country:US
Mailing Address - Phone:360-529-7287
Mailing Address - Fax:
Practice Address - Street 1:3525 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5010
Practice Address - Country:US
Practice Address - Phone:360-529-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist