Provider Demographics
NPI:1760940928
Name:BOHLMAN, ALEXANDRA LAUREN
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAUREN
Last Name:BOHLMAN
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 1:2208 NW MARKET ST STE 503
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4098
Mailing Address - Country:US
Mailing Address - Phone:206-635-3492
Mailing Address - Fax:
Practice Address - Street 1:2208 NW MARKET ST STE 503
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4098
Practice Address - Country:US
Practice Address - Phone:206-635-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61024752101Y00000X
WA61045464106H00000X
WAMG61045464106H00000X
WALF61303721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor