Provider Demographics
NPI:1699557306
Name:HESS, ALEXANDRA DANETTE (CLC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DANETTE
Last Name:HESS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:OH
Mailing Address - Zip Code:43928-0106
Mailing Address - Country:US
Mailing Address - Phone:740-632-0602
Mailing Address - Fax:
Practice Address - Street 1:50163 3RD ST
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:OH
Practice Address - Zip Code:43928-4392
Practice Address - Country:US
Practice Address - Phone:740-632-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant