MEDICARE: ALEXA HACKENBURG BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-79364	GA

General Provider Information

NPI Number	:	1336945674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA HACKENBURG BCBA

Provider Business Mailing Address
First Line	:	2047 LAKE PARK DR SE APT J
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7678
Country	:	US
Telephone Number	:	570-238-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	2047 LAKE PARK DR SE APT J
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7678
Country	:	US
Telephone Number	:	570-238-1957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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