Provider Demographics
NPI:1528942125
Name:RIDDLE, ALEXSANDRA
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5745
Mailing Address - Country:US
Mailing Address - Phone:417-818-6835
Mailing Address - Fax:
Practice Address - Street 1:11016 E STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9775
Practice Address - Country:US
Practice Address - Phone:417-527-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025030777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional