Provider Demographics
NPI:1578303558
Name:SIEMENSMA, ALEX MICHELLE
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:MICHELLE
Last Name:SIEMENSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 36TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2324
Mailing Address - Country:US
Mailing Address - Phone:562-445-9162
Mailing Address - Fax:
Practice Address - Street 1:4173 36TH ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2324
Practice Address - Country:US
Practice Address - Phone:562-445-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician