Individual
ALEXIS LYNETTE IZETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2656 POPLAR ST, PORTAGE, IN 46368-2941
(219) 238-8546
Mailing address
2656 POPLAR ST, PORTAGE, IN 46368-2941
(219) 238-8546
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IN
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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