Provider Demographics
NPI:1033953419
Name:LADD, ALEXA (LEP)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W SIERRA MADRE BLVD # 510
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2434
Mailing Address - Country:US
Mailing Address - Phone:845-519-9967
Mailing Address - Fax:
Practice Address - Street 1:80 W SIERRA MADRE BLVD # 510
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2434
Practice Address - Country:US
Practice Address - Phone:845-519-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4533103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool