Healthcare Provider Details

I. General information

NPI: 1821520289
Provider Name (Legal Business Name): ALEXA FRANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 WEST REYNOLDS AVE.
CENTRALIA WA
98531
US

IV. Provider business mailing address

2428 WEST REYNOLDS AVE.
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCG60629258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: