MEDICARE: VANESSA ALEXANDER

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	:	1588453757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ALEXANDER

Provider Business Mailing Address
First Line	:	18600 E 37TH TER S
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1707
Country	:	US
Telephone Number	:	816-656-7502
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 N ROCK RD STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2200
Country	:	US
Telephone Number	:	316-202-1921
Fax Number	:

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

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “ VANESSA ALEXANDER ” Practice Location

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