=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912097932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERI SUZANNE ALEXANDAR LSCW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 04/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1490 GRIMES ST
-----------------------------------------------------
City | FALLON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89406-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-423-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5461 DESERT PEACH DR
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-0862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-544-7132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 773
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------