Provider Demographics
NPI:1972308732
Name:ALEXANDER, DEJA NICOLE (PSYD)
Entity type:Individual
Prefix:
First Name:DEJA
Middle Name:NICOLE
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2616
Mailing Address - Country:US
Mailing Address - Phone:773-629-1267
Mailing Address - Fax:
Practice Address - Street 1:10801 S WESTERN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3225
Practice Address - Country:US
Practice Address - Phone:708-586-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071021020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical