Provider Demographics
NPI:1962396382
Name:LEDOUX, ALEXIS SUMMERVILLE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SUMMERVILLE
Last Name:LEDOUX
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 1:4140 RICHARD AVE # 200300
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2869
Mailing Address - Country:US
Mailing Address - Phone:218-520-3411
Mailing Address - Fax:
Practice Address - Street 1:4140 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2869
Practice Address - Country:US
Practice Address - Phone:218-520-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician