Individual
ALEXIS JASMINE MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 MARQUETTE ST, CREVE COEUR, IL 61610-3924
(309) 678-4807
Mailing address
225 MARQUETTE ST, CREVE COEUR, IL 61610-3924
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT006660
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2022
Last updated
06/30/2022
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