Provider Demographics
NPI:1043862188
Name:BOER, ALYSSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:BOER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WIN HENTSCHEL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4149
Mailing Address - Country:US
Mailing Address - Phone:765-444-3999
Mailing Address - Fax:
Practice Address - Street 1:1330 WIN HENTSCHEL BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4149
Practice Address - Country:US
Practice Address - Phone:765-444-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043195A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical