Individual
ALYSSA JANE REVOLINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
269435 S ELM LANE, WATERFORD, WI 53185
(262) 210-0272
Mailing address
33633 OAK KNOLL RD, BURLINGTON, WI 53105-6703
(262) 210-0272
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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