Individual
ALEXIS TIDBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ASW
Contact information
Practice address
121 DOWNEY AVE, MODESTO, CA 95354-1208
(209) 341-1824
Mailing address
1438 E J ST, OAKDALE, CA 95361-8862
(209) 247-6633
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
98746
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/24/2020
Last updated
07/15/2024
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