Healthcare Provider Details

I. General information

NPI: 1043131741
Provider Name (Legal Business Name): ALEXANDRA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 STATE ROUTE 20 SUITE 102
WINTHROP WA
98862
US

IV. Provider business mailing address

PO BOX 822
TWISP WA
98856-0822
US

V. Phone/Fax

Practice location:
  • Phone: 509-449-2179
  • Fax:
Mailing address:
  • Phone: 509-449-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61457133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: