Provider Demographics
NPI:1023456894
Name:LEDDY, ALEXANDRA ELIZABETH (LAC)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:LEDDY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 PAEPCKE DR
Mailing Address - Street 2:#201
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-6126
Mailing Address - Country:US
Mailing Address - Phone:970-309-5853
Mailing Address - Fax:
Practice Address - Street 1:225 N MILL ST STE 114
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1958
Practice Address - Country:US
Practice Address - Phone:970-309-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001897171100000X
CAAC 15315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist