1043986912 NPI number — MRS. ALYSSA ROSE BUGAYONG M.S. BCBA

Table of content: MRS. ALYSSA ROSE BUGAYONG M.S. BCBA (NPI 1043986912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043986912 NPI number — MRS. ALYSSA ROSE BUGAYONG M.S. BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUGAYONG
Provider First Name:
ALYSSA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CEJA
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043986912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14367 100TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YELM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98597-7751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-533-3222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
857 LEBLANC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05822-9553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-505-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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