Provider Demographics
NPI:1740770627
Name:CLEMENT, ALEXIS LEAANN
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:LEAANN
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:MO
Mailing Address - Zip Code:65239-1010
Mailing Address - Country:US
Mailing Address - Phone:816-612-2360
Mailing Address - Fax:
Practice Address - Street 1:414 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:MO
Practice Address - Zip Code:65239-1010
Practice Address - Country:US
Practice Address - Phone:816-612-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist