Provider Demographics
NPI:1265195192
Name:SHEHAN, ALEXANDRIA CHRISTINE (RBT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:CHRISTINE
Last Name:SHEHAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SIVERS RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1548
Mailing Address - Country:US
Mailing Address - Phone:712-527-3034
Mailing Address - Fax:
Practice Address - Street 1:400 SIVERS RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1548
Practice Address - Country:US
Practice Address - Phone:712-527-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-187923106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician