Basic Information
| Provider Information | |||||||||
| NPI: | 1033455217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOONAN | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | BROOKE-WALTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LLMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALTON | ||||||||
| OtherFirstName: | ALYSSA | ||||||||
| OtherMiddleName: | BROOKE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LLMSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2615 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431651 | ||||||||
| FaxNumber: | 2693827078 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431651 | ||||||||
| FaxNumber: | 2693827078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2012 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094279 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.