Provider Demographics
NPI:1770038127
Name:WALSH, ALEXANDRA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3070
Mailing Address - Country:US
Mailing Address - Phone:563-726-4750
Mailing Address - Fax:563-396-2060
Practice Address - Street 1:2435 KIMBERLY RD STE 270
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-726-4750
Practice Address - Fax:563-396-2060
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health