Provider Demographics
NPI:1780457077
Name:MASCHKE, ALISSA MARIE
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:MASCHKE
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 1:7131 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9225
Mailing Address - Country:US
Mailing Address - Phone:614-949-4271
Mailing Address - Fax:
Practice Address - Street 1:7131 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9225
Practice Address - Country:US
Practice Address - Phone:614-949-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician