Provider Demographics
NPI:1205189149
Name:NAZIMIEC, ALEXANDRA DANIELLE (MSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DANIELLE
Last Name:NAZIMIEC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:DANIELL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3113
Mailing Address - Country:US
Mailing Address - Phone:541-774-8201
Mailing Address - Fax:541-774-7979
Practice Address - Street 1:140 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3113
Practice Address - Country:US
Practice Address - Phone:541-774-8201
Practice Address - Fax:541-774-7979
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical