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Individual

ALYSSA GANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1401 LOS GAMOS DRIVE, SUITE 240, SAN RAFAEL, CA 94903
(415) 457-1925
Mailing address
1950 MATZEN RANCH CIRCLE, PETALUMA, CA 94954
(530) 524-2451

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
10/26/2015
Last updated
10/26/2015
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