Provider Demographics
NPI:1154204246
Name:FIDDLER, ALEXIS LEANN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LEANN
Last Name:FIDDLER
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 1:315 BARRICKS RD LOT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3017
Mailing Address - Country:US
Mailing Address - Phone:502-762-7561
Mailing Address - Fax:
Practice Address - Street 1:1707 CEDAR GROVE RD STE 5-7
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8572
Practice Address - Country:US
Practice Address - Phone:502-203-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst