Healthcare Provider Details

I. General information

NPI: 1679398820
Provider Name (Legal Business Name): ALEXANDRA NICOLE BERNITT MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N KNOXVILLE AVE
PEORIA IL
61603-3028
US

IV. Provider business mailing address

1800 N KNOXVILLE AVE
PEORIA IL
61603-3028
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-9680
  • Fax: 309-624-9524
Mailing address:
  • Phone: 309-624-9689
  • Fax: 309-624-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246000954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: