MEDICARE: ALYX MICHELE DUCKERING

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1699341396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYX MICHELE DUCKERING

Provider Business Mailing Address
First Line	:	5560 LEXINGTON AVE APT 278
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4149
Country	:	US
Telephone Number	:	909-744-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	15885 LOS GATOS ALMADEN RD
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-3803
Country	:	US
Telephone Number	:	408-409-4167
Fax Number	:

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

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	10/03/2022

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Directions to “ ALYX MICHELE DUCKERING ” Practice Location

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