MEDICARE: ALEXANDRA HYDE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1386210458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA HYDE

Provider Business Mailing Address
First Line	:	2155 VAN DYKE ST
Second Line	:
City	:	CONKLIN
State	:	MI
Zip	:	49403-9598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 BURTON ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-4927
Country	:	US
Telephone Number	:	616-214-8366
Fax Number	:

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

Provider Enumeration Date	:	05/31/2021
Last Update Date	:	05/31/2021

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Directions to “ ALEXANDRA HYDE ” Practice Location

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