Provider Demographics
NPI:1013055995
Name:ALEXANDER, MARI KRESGE (PA-C, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:KRESGE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA-C, LMFT
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:ELIZABETH
Other - Last Name:RILEY-KRESGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, LMFT
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-0568
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-352-8658
Practice Address - Street 1:226 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-601-7400
Practice Address - Fax:503-601-7311
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0523106H00000X
ORPA01219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669279Medicaid