Provider Demographics
NPI:1649772609
Name:MERRYMAN, ALEXANDREA FRANCESCA (BCBA, LBA, MS)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDREA
Middle Name:FRANCESCA
Last Name:MERRYMAN
Suffix:
Gender:F
Credentials:BCBA, LBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1513
Mailing Address - Country:US
Mailing Address - Phone:360-773-0311
Mailing Address - Fax:
Practice Address - Street 1:720 SE 160TH AVE # 154
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8911
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALBA.BA.61349533103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician