| Doctor Name: | ALEXA GLICK |
| NPI Number: | 1871995597 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 511964393 |
| Business Practice Address: | 5536 Mansfield Pl Nw Albuquerque, NM - 871141538 |
| Business Phone Number: | 6308624736 |
| Business Fax Number: | |
| Mailing Address: | 5536 Mansfield Pl Nw, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871141538 |
| Phone Number: | 6308624736 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2014 |
| NPI Last Update Date: | 09/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 373H00000X |
| License Number: | 511964393 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Day Training/Habilitation Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living. |