Healthcare Provider Details

I. General information

NPI: 1306340740
Provider Name (Legal Business Name): ALEXA GALLOWAY BCBA/COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W SCHROCK RD
WESTERVILLE OH
43081-2890
US

IV. Provider business mailing address

DEPT 781625
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-7570
  • Fax:
Mailing address:
  • Phone: 614-355-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.00778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: