Provider / Organization | NPI | Date Certified |
---|---|---|
ALEXIS BLACK | 1679162218 | 2021-01-17 |
Alexis Black is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1679162218. Registration indicates Alexis Black is a provider of services with a specialization in Other Service Providers, Case Manager/Care Coordinator (Case Manager/Care Coordinator, ) (All Other Specialties & Provider Types, ) (Case Manager/Care Coordinator, Other Service Providers)
Entity Type | Individual |
Provider Name | Alexis Black |
Practice Office Address | 847 NE 19TH AVE PORTLAND, OR US |
Practice Office Telephone | 5032380769 |
Mailing Address | 2152 NE WASCO ST PORTLAND, OR 972321619 US |
Business Telephone | 5037079019 |
Code | Practice | License No State |
---|---|---|
171M00000X PRIMARY | Other Service Providers Case Manager/Care Coordinator Case Manager/Care Coordinator All Other Specialties & Provider Types Case Manager/Care Coordinator Other Service Providers |