Healthcare Provider Details

I. General information

NPI: 1588294474
Provider Name (Legal Business Name): ALEXANDRIA HEPBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 KINGSBURY ST
MAUMEE OH
43537-1865
US

IV. Provider business mailing address

615 KINGSBURY ST
MAUMEE OH
43537-1865
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-0185
  • Fax: 419-930-6721
Mailing address:
  • Phone: 567-218-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: