Provider Demographics
NPI:1922209261
Name:ALEXANDER, JANNETTE GOULD (EDD)
Entity Type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:GOULD
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 TRAVERS CIR
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3716
Mailing Address - Country:US
Mailing Address - Phone:574-252-5725
Mailing Address - Fax:
Practice Address - Street 1:3130 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4736
Practice Address - Country:US
Practice Address - Phone:574-344-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical