Alyssa Mae Koktavy Israel, MSW, LGSW
Individual provider Active NPI School Social Worker · Cook, MN
NPI 1063208171 · NPPES record last updated Apr 16, 2025
Key facts
- NPI
- 1063208171
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Social Worker 1041S0200X
- License
- 34288 (MN)
- Practice address
- 10248 E Olson Rd
Cook, MN 55723-8184 - Phone
- (218) 666-5221
- NPI assigned
- Apr 16, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34288 | MN | MD | School Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 34288 | MN | Yes |
Addresses
Primary practice location
10248 E Olson Rd
Cook, MN 55723-8184
Mailing address
116 12TH St S
Virginia, MN 55792-2918
Phone (507) 581-2510
Other providers in Cook, MN
- Kelli Hansen
- Ida B Haxton
- Bradley Scott Horoshak
- Mary Frances Hughes
- Joanne K Intveld
- Dayton Nels Johnson
- Jerel Dean Johnson
- Harold D Johnston
- Harpreet Kaur
- Amy Kemp
All providers in Cook, MN · School Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.