Provider Demographics
NPI:1518134865
Name:ALEXANDER, IRENE STACEY (LMP)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:STACEY
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11509 SW COVE RD APT 101
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-4001
Mailing Address - Country:US
Mailing Address - Phone:206-455-5426
Mailing Address - Fax:
Practice Address - Street 1:17141 VASHON HWY SW # 106
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4603
Practice Address - Country:US
Practice Address - Phone:206-455-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024983225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist