Healthcare Provider Details

I. General information

NPI: 1134832983
Provider Name (Legal Business Name): ALEXANDRA DIANE SECKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLIE SECKEL

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 W CHURCH ST
NEWARK OH
43055-5050
US

IV. Provider business mailing address

2379 CRAMER RD
MARION OH
43302-9436
US

V. Phone/Fax

Practice location:
  • Phone: 740-281-1777
  • Fax:
Mailing address:
  • Phone: 740-971-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2202795TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: