Provider Demographics
NPI:1609395581
Name:PERDUE, ALEXANDRA (EDS)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PERDUE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 BRISCO RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2562
Mailing Address - Country:US
Mailing Address - Phone:630-677-4727
Mailing Address - Fax:
Practice Address - Street 1:185 BRISCO RD UNIT C
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2562
Practice Address - Country:US
Practice Address - Phone:630-677-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160058816103TS0200X
IL2040779103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool