Provider Demographics
NPI:1487250874
Name:LADD, ALYSSA FAITH
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:FAITH
Last Name:LADD
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 1:650 CHURCH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1689
Mailing Address - Country:US
Mailing Address - Phone:425-424-2378
Mailing Address - Fax:425-424-2378
Practice Address - Street 1:950 W. MONROE JACKSON, MI 49202
Practice Address - Street 2:950 W. MONROE JACKSON, MI 49202
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4920
Practice Address - Country:US
Practice Address - Phone:517-795-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician