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NPI Code Detail

MEDICARE: MICHELLE M ALEXANDER LW, PHD, BCBA, LBA

MEDICARE: MICHELLE M ALEXANDER LW, PHD, BCBA, LBA
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
11041C0700XClinical Social WorkerLW60485498WA
21041C0700XClinical Social WorkerISW01732RI
3103K00000XBehavior AnalystBA60813130WA

General Provider Information

NPI Number : 1831157171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE M ALEXANDER LW, PHD, BCBA, LBA
Provider Business Mailing Address
First Line : PO BOX 4188
Second Line :
City : BREMERTON
State : WA
Zip : 98312-0188
Country : US
Telephone Number : 360-633-2417
Fax Number :
Provider Business Practice Location Address
First Line : 13765 VINTAGE DR SW
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98367-7391
Country : US
Telephone Number : 253-970-2414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 09/25/2020

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