Provider Demographics
NPI:1033944756
Name:PEEL, ALEXANDRA KATHLEEN (SWLC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHLEEN
Last Name:PEEL
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318A MARY JANE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5889
Mailing Address - Country:US
Mailing Address - Phone:480-202-8106
Mailing Address - Fax:
Practice Address - Street 1:2318A MARY JANE BLVD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5889
Practice Address - Country:US
Practice Address - Phone:480-202-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-569251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical