Provider Demographics
NPI:1427727122
Name:SORENSEN-WILSON, ALEXA DANIK
Entity type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:DANIK
Last Name:SORENSEN-WILSON
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 1:19023 36TH AVE W STE B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5764
Mailing Address - Country:US
Mailing Address - Phone:425-293-2557
Mailing Address - Fax:
Practice Address - Street 1:19023 36TH AVE W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5764
Practice Address - Country:US
Practice Address - Phone:425-293-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician