Provider Demographics
NPI:1134820343
Name:VANORDEN, ALEXIS
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:
Last Name:VANORDEN
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 1:4000 BRINKER AVE APT 46
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2446
Mailing Address - Country:US
Mailing Address - Phone:180-182-9845
Mailing Address - Fax:
Practice Address - Street 1:4000 BRINKER AVE APT 46
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2446
Practice Address - Country:US
Practice Address - Phone:180-182-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician