Healthcare Provider Details

I. General information

NPI: 1992444962
Provider Name (Legal Business Name): ALEXANDRA RHODES HOOTEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA RHODES GOUGH

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SMITH RD STE A6
NORWOOD OH
45212-2793
US

IV. Provider business mailing address

153 W KINDERTON WAY APT 108
BERMUDA RUN NC
27006-7392
US

V. Phone/Fax

Practice location:
  • Phone: 513-518-0594
  • Fax:
Mailing address:
  • Phone: 513-518-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP.08249
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: