Basic Information
Provider Information
NPI: 1467952986
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTPLAISIR
FirstName: ALYSON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 45 10TH ST W
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551021062
CountryCode: US
TelephoneNumber: 6512323000
FaxNumber:  
Practice Location
Address1: 540 E 1ST ST
Address2:  
City: WACONIA
State: MN
PostalCode: 553871600
CountryCode: US
TelephoneNumber: 9524424437
FaxNumber: 9524423084
Other Information
ProviderEnumerationDate: 02/21/2018
LastUpdateDate: 08/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X19794MNY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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