Provider Demographics
NPI:1699341396
Name:DUCKERING, ALYX MICHELE
Entity type:Individual
Prefix:
First Name:ALYX
Middle Name:MICHELE
Last Name:DUCKERING
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 1:5560 LEXINGTON AVE APT 278
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4149
Mailing Address - Country:US
Mailing Address - Phone:909-744-2412
Mailing Address - Fax:
Practice Address - Street 1:15885 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3803
Practice Address - Country:US
Practice Address - Phone:408-409-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program