Provider Demographics
NPI:1588152953
Name:SAARI ELLIS, ALEXANDRA (LMSW, DP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SAARI ELLIS
Suffix:
Gender:F
Credentials:LMSW, DP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:BRITTANY
Other - Last Name:SAARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3009
Mailing Address - Country:US
Mailing Address - Phone:906-273-0964
Mailing Address - Fax:906-273-2005
Practice Address - Street 1:1209 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3009
Practice Address - Country:US
Practice Address - Phone:906-273-0964
Practice Address - Fax:906-273-2005
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851102332104100000X
MI6801117674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801117674OtherSTATE LICENSE
MI6801102332OtherLLMSW STATE LICENSURE