Healthcare Provider Details

I. General information

NPI: 1831157171
Provider Name (Legal Business Name): MICHELLE M ALEXANDER LW, PHD, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13765 VINTAGE DR SW
PORT ORCHARD WA
98367-7391
US

IV. Provider business mailing address

PO BOX 4188
BREMERTON WA
98312-0188
US

V. Phone/Fax

Practice location:
  • Phone: 253-970-2414
  • Fax:
Mailing address:
  • Phone: 360-633-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60485498
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01732
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA60813130
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: