Provider Demographics
NPI:1841766771
Name:EVENSON, ALYSSA KAY (LICSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KAY
Last Name:EVENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KAY
Other - Last Name:RADEMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2900
Mailing Address - Country:US
Mailing Address - Phone:763-581-5372
Mailing Address - Fax:763-581-6401
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2900
Practice Address - Country:US
Practice Address - Phone:763-581-5372
Practice Address - Fax:763-581-6401
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21265104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker