Healthcare Provider Details

I. General information

NPI: 1790606523
Provider Name (Legal Business Name): ALEXANDRA H KOOPMAN LW61313713
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N ALDER ST
TACOMA WA
98407-6221
US

IV. Provider business mailing address

1402 S PINE ST
TACOMA WA
98405-2475
US

V. Phone/Fax

Practice location:
  • Phone: 253-970-9527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61313713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: