Provider Demographics
NPI:1275264939
Name:PAQUE, ALEXANDER HELANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HELANDER
Last Name:PAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 S 102ND STREET
Mailing Address - Street 2:APT.205B
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:192-056-2432
Mailing Address - Fax:
Practice Address - Street 1:2054 S 102ND STREET
Practice Address - Street 2:APT.205B
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:920-562-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty