Provider Demographics
NPI:1104604933
Name:WIRTH, ALEXANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WIRTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:5901 WESTOWN PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8297
Mailing Address - Country:US
Mailing Address - Phone:515-344-2060
Mailing Address - Fax:
Practice Address - Street 1:5901 WESTOWN PKWY STE 230
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8297
Practice Address - Country:US
Practice Address - Phone:515-344-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1211061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical