Healthcare Provider Details

I. General information

NPI: 1710720461
Provider Name (Legal Business Name): ALEXIS PRIES DT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

IV. Provider business mailing address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-0857
  • Fax: 815-434-2260
Mailing address:
  • Phone: 815-434-0857
  • Fax: 815-434-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: