Healthcare Provider Details

I. General information

NPI: 1861305542
Provider Name (Legal Business Name): ALEXANDRIA IVERY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MAIN AVE STE 260
DURANGO CO
81301-5083
US

IV. Provider business mailing address

11814 COUNTY ROAD 250
DURANGO CO
81301-8614
US

V. Phone/Fax

Practice location:
  • Phone: 970-426-5003
  • Fax:
Mailing address:
  • Phone: 970-426-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-275183
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: