Provider Demographics
NPI:1588467088
Name:KREIDER, ALEXANDER J
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:KREIDER
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 1:2192 SE SEDGWICK RD UNIT J102
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-9557
Mailing Address - Country:US
Mailing Address - Phone:425-295-5279
Mailing Address - Fax:
Practice Address - Street 1:1950 POTTERY AVE STE 124
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2501
Practice Address - Country:US
Practice Address - Phone:855-201-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician