MEDICARE: ALEXANDRA TYLUTKI

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1619408127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA TYLUTKI

Provider Business Mailing Address
First Line	:	5959 E NORTHWEST HWY
Second Line	:	APARTMENT #2014
City	:	DALLAS
State	:	TX
Zip	:	75231-0402
Country	:	US
Telephone Number	:	530-906-4941
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 E NORTHWEST HWY
Second Line	:	APARTMENT #2014
City	:	DALLAS
State	:	TX
Zip	:	75231-0402
Country	:	US
Telephone Number	:	530-906-4941
Fax Number	:

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

Provider Enumeration Date	:	03/26/2017
Last Update Date	:	03/26/2017

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Directions to “ ALEXANDRA TYLUTKI ” Practice Location

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