Provider Demographics
NPI:1679141949
Name:SCHILLING, ALYSSA NICOLE (MA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NICOLE
Last Name:SCHILLING
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 1:4800 OLSON MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:507-474-6264
Mailing Address - Fax:507-218-8553
Practice Address - Street 1:4800 OLSON MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:507-474-6264
Practice Address - Fax:507-218-8553
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program