Healthcare Provider Details

I. General information

NPI: 1407253222
Provider Name (Legal Business Name): ALEXIS SANDERS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N 2ND ST
ROGERS AR
72756-6647
US

IV. Provider business mailing address

1714 S 11TH ST
ROGERS AR
72756-5200
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-4207
  • Fax: 479-935-3180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8901-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8901-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: