Healthcare Provider Details

I. General information

NPI: 1811805005
Provider Name (Legal Business Name): CA TISA LAJE ALEXANDER CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 XENIA AVE
DAYTON OH
45410-1824
US

IV. Provider business mailing address

526 XENIA AVE
DAYTON OH
45410-1824
US

V. Phone/Fax

Practice location:
  • Phone: 937-949-1524
  • Fax: 937-791-6613
Mailing address:
  • Phone: 937-949-1524
  • Fax: 937-791-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: