Healthcare Provider Details

I. General information

NPI: 1982289096
Provider Name (Legal Business Name): ALEXIS REANNE ARSENAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS REANNE ROGERS

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 ORCHARD ST W
UNIVERSITY PLACE WA
98467-3824
US

IV. Provider business mailing address

7172 HOLLOWAY ST # A
JOINT BASE LEWIS MCCHORD WA
98433-1942
US

V. Phone/Fax

Practice location:
  • Phone: 253-414-7461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: