Provider Demographics
NPI:1235713819
Name:TRUDEAU, LEXIE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LEXIE
Middle Name:MARIE
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S EASTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2146
Mailing Address - Country:US
Mailing Address - Phone:855-755-3797
Mailing Address - Fax:
Practice Address - Street 1:6744 FLINTWOOD ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8694
Practice Address - Country:US
Practice Address - Phone:603-521-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW13743104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker