Individual
ALLYSON THAMMACHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 GOSHEN RD, FORT WAYNE, IN 46808-1493
(260) 471-3500
Mailing address
2621 E JEFFERSON ST, WARSAW, IN 46580-3880
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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