Provider Demographics
NPI:1851056741
Name:HANSON, ALEXA L
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:L
Last Name:HANSON
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 1:6111 SPRINGFORD DR APT M11
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4877
Mailing Address - Country:US
Mailing Address - Phone:610-704-1955
Mailing Address - Fax:
Practice Address - Street 1:7540 ALLENTOWN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4238
Practice Address - Country:US
Practice Address - Phone:717-418-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-17-28973106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician