MEDICARE: MRS. AMANDA ALEXANDER CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	258172	KY
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114338605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA ALEXANDER CSW

Provider Business Mailing Address
First Line	:	4010 DUPONT CIR
Second Line	:	SUITE 582
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4812
Country	:	US
Telephone Number	:	502-899-5411
Fax Number	:	502-899-5411

Provider Business Practice Location Address
First Line	:	4010 DUPONT CIR
Second Line	:	SUITE 582
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4812
Country	:	US
Telephone Number	:	502-899-5411
Fax Number	:	502-899-5411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	03/11/2026

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