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General NPI Number Information
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NPI Number | 1740387828
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Entity Type | Organization
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Legal Business Name | ALEXANDER PROFESSIONAL
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 2633 STATE ROUTE 59 SUITE E
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City | RAVENNA
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State | OH
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Zip | 44266-1684
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Country | US
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Telephone | 330-296-2829
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Fax | 330-541-2732
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Provider Business Mailing Address
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Address Line | PO BOX 1474
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City | KENT
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State | OH
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Zip | 44240-0028
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Country | US
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Telephone | 330-296-2809
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Fax | 330-296-2800
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN EDWARD ALEXANDER
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Credential | PH.D
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Telephone | 330-296-2809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3504
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License Number State | OH
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