Healthcare Provider Details

I. General information

NPI: 1053043596
Provider Name (Legal Business Name): ALEXIS NEIRYNCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14813 W 101ST AVE
DYER IN
46311
US

IV. Provider business mailing address

8200 GEORGIA ST
MERRILLVILLE IN
46410-6227
US

V. Phone/Fax

Practice location:
  • Phone: 219-245-7970
  • Fax:
Mailing address:
  • Phone: 219-791-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88711
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: