Provider Demographics
NPI:1841068707
Name:PAQUE, ALEXANDRA (MT-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PAQUE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 LYNN AVE UNIT 44
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2963
Mailing Address - Country:US
Mailing Address - Phone:262-623-4980
Mailing Address - Fax:
Practice Address - Street 1:626 LYNN AVE UNIT 44
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2963
Practice Address - Country:US
Practice Address - Phone:262-623-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist