Provider Demographics
NPI:1073223319
Name:MCKAY, ALEXIA JENAE
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:JENAE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13824 12ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319
Mailing Address - Country:US
Mailing Address - Phone:320-330-8817
Mailing Address - Fax:
Practice Address - Street 1:314 10TH AVE S #100
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387
Practice Address - Country:US
Practice Address - Phone:651-767-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician