Provider Demographics
NPI:1447136841
Name:LEDESMA, ALYSSA GRACE RODRIGUEZ (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:ALYSSA GRACE
Middle Name:RODRIGUEZ
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:LEDESMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSWAIC
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5137
Mailing Address - Country:US
Mailing Address - Phone:206-519-2476
Mailing Address - Fax:
Practice Address - Street 1:17018 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5137
Practice Address - Country:US
Practice Address - Phone:206-519-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWIA.SC.616287601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical