Provider Demographics
NPI:1447827019
Name:LA, ALEXANDRIA RYAN (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:RYAN
Last Name:LA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E BELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3872
Mailing Address - Country:US
Mailing Address - Phone:989-953-5831
Mailing Address - Fax:
Practice Address - Street 1:1750 E BELLOWS ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3872
Practice Address - Country:US
Practice Address - Phone:989-953-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099127104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker