Provider Demographics
NPI:1023645546
Name:FEENEY, ALYSIA LE
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:LE
Last Name:FEENEY
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 1:3498 WILD PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3963
Mailing Address - Country:US
Mailing Address - Phone:630-715-1622
Mailing Address - Fax:630-262-0996
Practice Address - Street 1:3498 WILD PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3963
Practice Address - Country:US
Practice Address - Phone:630-715-1622
Practice Address - Fax:630-262-0996
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional