Provider Demographics
NPI:1699266940
Name:ROWELL, ALEXANDER C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:C
Last Name:ROWELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 SW BLUESTEM PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1354
Mailing Address - Country:US
Mailing Address - Phone:541-590-6100
Mailing Address - Fax:
Practice Address - Street 1:216 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4812
Practice Address - Country:US
Practice Address - Phone:541-590-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical