Provider Demographics
NPI:1528507928
Name:RUBLE, ALEXIS KATHLEEN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KATHLEEN
Last Name:RUBLE
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 1:190 W 8TH AVE
Mailing Address - Street 2:APT B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2312
Mailing Address - Country:US
Mailing Address - Phone:937-728-7541
Mailing Address - Fax:
Practice Address - Street 1:5000 ARLINGTON CENTRE BLVD
Practice Address - Street 2:BUILDING 2
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-3075
Practice Address - Country:US
Practice Address - Phone:614-615-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTW457649106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician