Provider Demographics
NPI:1477292712
Name:FRIES, ALISON WISMER (PHD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:WISMER
Last Name:FRIES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:BETH
Other - Last Name:WISMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2012
Mailing Address - Country:US
Mailing Address - Phone:715-258-6342
Mailing Address - Fax:715-258-6409
Practice Address - Street 1:811 HARDING ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2012
Practice Address - Country:US
Practice Address - Phone:715-258-6342
Practice Address - Fax:715-258-6409
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3788-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical