Provider Demographics
NPI:1265881791
Name:ANDERSON, ALEC FREDERICK (PSYD, HSPP)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:FREDERICK
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MERCY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7300
Mailing Address - Country:US
Mailing Address - Phone:563-584-3500
Mailing Address - Fax:563-584-3520
Practice Address - Street 1:200 MERCY DR STE 201
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7300
Practice Address - Country:US
Practice Address - Phone:563-584-3500
Practice Address - Fax:563-584-3520
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100523103TC0700X
IN20043196A103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical