MEDICARE: ALEXA ALLEN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	110019	TX

General Provider Information

NPI Number	:	1134843477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA ALLEN CCC-SLP

Provider Business Mailing Address
First Line	:	110 E GARNER ST
Second Line	:
City	:	DETROIT
State	:	TX
Zip	:	75436-1944
Country	:	US
Telephone Number	:	903-674-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E GARNER ST
Second Line	:
City	:	DETROIT
State	:	TX
Zip	:	75436-1944
Country	:	US
Telephone Number	:	903-674-2244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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Directions to “ ALEXA ALLEN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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