Healthcare Provider Details

I. General information

NPI: 1831912781
Provider Name (Legal Business Name): ALICEA LIVI BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 E NORTHFIELD BLVD UNIT 3700
DENVER CO
80238-3135
US

IV. Provider business mailing address

4662 E BEVERLY LN
PHOENIX AZ
85032-3409
US

V. Phone/Fax

Practice location:
  • Phone: 480-757-8090
  • Fax:
Mailing address:
  • Phone: 617-686-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-325013
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: