Healthcare Provider Details

I. General information

NPI: 1275877193
Provider Name (Legal Business Name): ALEXANDRA LEDUC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD #6
LAS VEGAS NV
89102-0116
US

IV. Provider business mailing address

10548 BARDILINO ST
LAS VEGAS NV
89141-4252
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax:
Mailing address:
  • Phone: 949-412-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6343-S
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6835-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: