Healthcare Provider Details

I. General information

NPI: 1710823356
Provider Name (Legal Business Name): ALEXIS FRIEND
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 BUDDY HOLLY PL
CLEAR LAKE IA
50428-3735
US

IV. Provider business mailing address

1431 N MONROE AVE
MASON CITY IA
50401-1045
US

V. Phone/Fax

Practice location:
  • Phone: 641-352-7671
  • Fax:
Mailing address:
  • Phone: 209-843-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: