Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3404-57 | WI |
Y | 103T00000X | Psychologist | 3404-57 | WI |
NPI | 1013464049 |
---|---|
Provider Name | Alyssa Walsh |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705-2274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 21/01/2021 |