Basic Information
Provider Information
NPI: 1972710549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHLEISS
FirstName: ALEXIS
MiddleName: LINDSAY
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 955 POWELL AVE SW
Address2:  
City: RENTON
State: WA
PostalCode: 980572908
CountryCode: US
TelephoneNumber: 4252771311
FaxNumber:  
Practice Location
Address1: 126 AUBURN AVE STE 300
Address2:  
City: AUBURN
State: WA
PostalCode: 980025082
CountryCode: US
TelephoneNumber: 2537350166
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2007
LastUpdateDate: 12/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000XLW60725750WAY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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