MEDICARE: ALEXANDRA MARIE VAN LINGEN

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	103K00000X	Behavior Analyst	BEH-001687	AZ

General Provider Information

NPI Number	:	1275023194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MARIE VAN LINGEN

Provider Business Mailing Address
First Line	:	11005 W MCKINLEY ST
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-0026
Country	:	US
Telephone Number	:	720-556-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4873
Country	:	US
Telephone Number	:	720-556-6597
Fax Number	:

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

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	01/12/2026

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