Individual
ALYSSA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
245 N METRO DR, APPLETON, WI 54913-8572
(920) 903-1009
Mailing address
245 N METRO DR, APPLETON, WI 54913-8572
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
12186
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12186
CBMT
—
Enumeration date
05/06/2021
Last updated
05/06/2021
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