Provider Demographics
NPI:1639568215
Name:GROSS, ALEXA RENEE (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:RENEE
Last Name:GROSS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3401
Mailing Address - Country:US
Mailing Address - Phone:419-302-2286
Mailing Address - Fax:
Practice Address - Street 1:2393 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3401
Practice Address - Country:US
Practice Address - Phone:419-302-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-14-9735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist