Provider Demographics
NPI:1104602671
Name:WOLSCHON, ALYXANDRA
Entity type:Individual
Prefix:
First Name:ALYXANDRA
Middle Name:
Last Name:WOLSCHON
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 1:11102 ROSEATE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3382
Mailing Address - Country:US
Mailing Address - Phone:727-858-3337
Mailing Address - Fax:
Practice Address - Street 1:1050 QUEEN ST STE 100
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4130
Practice Address - Country:US
Practice Address - Phone:727-858-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician