Provider Demographics
NPI:1245267707
Name:ALEXANDER, JOHN EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1474
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-0028
Mailing Address - Country:US
Mailing Address - Phone:330-296-2809
Mailing Address - Fax:330-296-2800
Practice Address - Street 1:2633 STATE ROUTE 59
Practice Address - Street 2:SUITE E
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1684
Practice Address - Country:US
Practice Address - Phone:330-296-2809
Practice Address - Fax:330-296-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH62003504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450962Medicaid
OHCP02972Medicare PIN
OH0450962Medicaid