Healthcare Provider Details

I. General information

NPI: 1679164628
Provider Name (Legal Business Name): ALEXANDRA EWALD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9374 OLIVE BLVD
SAINT LOUIS MO
63132-3267
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-2402
  • Fax: 314-666-9770
Mailing address:
  • Phone: 407-807-7798
  • Fax: 407-588-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number25-82369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: