Provider Demographics
NPI:1326840596
Name:SEDERBERG, ALEXIS YVONNE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:YVONNE
Last Name:SEDERBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 E APPLE TREE LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-1020
Mailing Address - Country:US
Mailing Address - Phone:360-529-7056
Mailing Address - Fax:
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4566
Practice Address - Country:US
Practice Address - Phone:208-741-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker