Provider Demographics
NPI:1528051117
Name:ALEXANDER, JOY COLETTE (LISW)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:COLETTE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:COLETTE
Other - Last Name:FULLENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:311 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:IA
Mailing Address - Zip Code:52554-9619
Mailing Address - Country:US
Mailing Address - Phone:641-777-1842
Mailing Address - Fax:641-777-1842
Practice Address - Street 1:311 ELM ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:IA
Practice Address - Zip Code:52554-9619
Practice Address - Country:US
Practice Address - Phone:641-777-1842
Practice Address - Fax:641-777-1842
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00107101YA0400X
IA04839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA208001OtherIOWA HEALTH SOLUTIONS
IA48692OtherWELLMARK BCBS OF IOWA
IA800013210OtherRAILROAD MEDICARE
IA420581060A8OtherJOHN DEERE HEALTH
IA0268748Medicaid
IA420681060A8OtherUNITED BEHAVIORAL HEALTH
IA208001OtherIOWA HEALTH SOLUTIONS
P62336Medicare UPIN