Provider Demographics
NPI:1770119281
Name:ALEXANDER, DIANE LAUREN (PSYD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LAUREN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DUNLAP CT
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9501
Mailing Address - Country:US
Mailing Address - Phone:708-373-3481
Mailing Address - Fax:
Practice Address - Street 1:7 DUNLAP CT
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9501
Practice Address - Country:US
Practice Address - Phone:217-352-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011164103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral