Provider Demographics
NPI:1679380075
Name:SHAW, ALEXIS N
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:N
Last Name:SHAW
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:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-0250
Mailing Address - Country:US
Mailing Address - Phone:888-238-1818
Mailing Address - Fax:855-915-1521
Practice Address - Street 1:201 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1904
Practice Address - Country:US
Practice Address - Phone:317-732-8380
Practice Address - Fax:855-892-0299
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-376062106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician