Provider Demographics
NPI:1588227268
Name:QUIGLEY, ALEXANDRIA PHOENIX
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:PHOENIX
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALEXANDRIA
Other - Middle Name:PHOENIX
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 SE WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9353
Mailing Address - Country:US
Mailing Address - Phone:360-621-0164
Mailing Address - Fax:
Practice Address - Street 1:50 SE WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9353
Practice Address - Country:US
Practice Address - Phone:360-621-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician