Provider Demographics
NPI:1841766771
Name:RADEMACHER, ALYSSA KAY
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KAY
Last Name:RADEMACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KAY
Other - Last Name:EVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2900
Mailing Address - Country:US
Mailing Address - Phone:763-581-5372
Mailing Address - Fax:763-581-6401
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2900
Practice Address - Country:US
Practice Address - Phone:763-581-5372
Practice Address - Fax:763-581-6401
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21265104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker