Provider Demographics
NPI:1417747486
Name:AGUIRRE, ALYSSA M
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:M
Last Name:AGUIRRE
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 1:609 W HEALEY ST APT 14
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5068
Mailing Address - Country:US
Mailing Address - Phone:331-643-8602
Mailing Address - Fax:
Practice Address - Street 1:411 E PARK ST STE 106
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3862
Practice Address - Country:US
Practice Address - Phone:331-643-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker