Provider Demographics
NPI:1639905904
Name:WILSON, ALYSSA ROSEMARIE (MA)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ROSEMARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 S SHORE DRIVE
Mailing Address - Street 2:APT 1405
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:407-403-9769
Mailing Address - Fax:
Practice Address - Street 1:5500 S SHORE DRIVE
Practice Address - Street 2:APT 1405
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:407-403-9769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker