Provider Demographics
NPI:1760234660
Name:ALEXANDER, LEEANDER (MHA)
Entity Type:Individual
Prefix:
First Name:LEEANDER
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S AUSTIN BLVD APT H
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2339
Mailing Address - Country:US
Mailing Address - Phone:708-901-6422
Mailing Address - Fax:
Practice Address - Street 1:1010 S AUSTIN BLVD APT H
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2339
Practice Address - Country:US
Practice Address - Phone:708-901-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker