Provider Demographics
NPI:1568054963
Name:SWICEGOOD, ALEXANDRIA LESLIE
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LESLIE
Last Name:SWICEGOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:LESLIE
Other - Last Name:FOLGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 W AVENUE E APT B
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2174
Mailing Address - Country:US
Mailing Address - Phone:254-247-5441
Mailing Address - Fax:
Practice Address - Street 1:3715 S 1ST ST APT 464
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-0109
Practice Address - Country:US
Practice Address - Phone:254-247-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-154829OtherREGISTERED BEHAVIOR TECHNICHIAN