Provider Demographics
NPI:1063013597
Name:VAN HOUSEN, ALEXANDRA C (MA 61096188)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:C
Last Name:VAN HOUSEN
Suffix:
Gender:F
Credentials:MA 61096188
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 1ST ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-8993
Mailing Address - Country:US
Mailing Address - Phone:509-992-8132
Mailing Address - Fax:
Practice Address - Street 1:3209 E 57TH AVE STE H
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7040
Practice Address - Country:US
Practice Address - Phone:509-448-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61096188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist