Healthcare Provider Details

I. General information

NPI: 1609395581
Provider Name (Legal Business Name): ALEXANDRA PERDUE ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BRISCO RD UNIT C
ARROYO GRANDE CA
93420-2562
US

IV. Provider business mailing address

185 BRISCO RD UNIT C
ARROYO GRANDE CA
93420-2562
US

V. Phone/Fax

Practice location:
  • Phone: 630-677-4727
  • Fax:
Mailing address:
  • Phone: 630-677-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number160058816
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2040779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: