Healthcare Provider Details

I. General information

NPI: 1871046292
Provider Name (Legal Business Name): ALEXANDRA THOMPSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ALEXANDRA NIELSEN

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 BONFORTE BLVD STE D
PUEBLO CO
81001-1680
US

IV. Provider business mailing address

1624 BONFORTE BLVD STE D
PUEBLO CO
81001-1680
US

V. Phone/Fax

Practice location:
  • Phone: 719-248-0043
  • Fax:
Mailing address:
  • Phone: 719-248-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNLC.0106553
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09926595
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: