Provider Demographics
NPI:1366209181
Name:DREIXLER, CARLY ALESSIA
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ALESSIA
Last Name:DREIXLER
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 1:1830 KLEVEN LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7127
Mailing Address - Country:US
Mailing Address - Phone:219-895-6405
Mailing Address - Fax:
Practice Address - Street 1:1830 KLEVEN LN
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7127
Practice Address - Country:US
Practice Address - Phone:219-895-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9370-22-2449103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst