Provider Demographics
NPI:1801374160
Name:SIEGRIST, ALLYSSA RE'ANNE
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:RE'ANNE
Last Name:SIEGRIST
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 1:379 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4379
Mailing Address - Country:US
Mailing Address - Phone:541-294-9354
Mailing Address - Fax:
Practice Address - Street 1:1431 AIRPORT LN
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2008
Practice Address - Country:US
Practice Address - Phone:545-464-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor