MEDICARE: MRS. ALEXIS CORINNE NORMANDEAU ME

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	LBA.BA.70064166	WA

General Provider Information

NPI Number	:	1861956492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXIS CORINNE NORMANDEAU ME

Provider Business Mailing Address
First Line	:	19600 NE 3RD ST APT 23A
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7807
Country	:	US
Telephone Number	:	360-609-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105D 15TH AVE
Second Line	:	#123
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3080
Country	:	US
Telephone Number	:	185-583-2672
Fax Number	:

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

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/27/2026

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