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NPI Code Detail

MEDICARE: ALEXANDRIA PORTILLO MA, SLP-CCC

MEDICARE: ALEXANDRIA PORTILLO MA, SLP-CCC
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
1235Z00000XSpeech-Language Pathologist14229709CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114229709OTHERAMERICAN SPEECH AND HEARING ASSOCIATION

General Provider Information

NPI Number : 1144782921
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRIA PORTILLO MA, SLP-CCC
Provider Business Mailing Address
First Line : 1901 MANITOBA DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80910-3322
Country : US
Telephone Number : 505-660-3457
Fax Number :
Provider Business Practice Location Address
First Line : 17230 JACKSON CREEK PKWY STE 220
Second Line :
City : MONUMENT
State : CO
Zip : 80132-7304
Country : US
Telephone Number : 719-488-3348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2019
Last Update Date : 02/12/2024

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Directions to “ ALEXANDRIA PORTILLO MA, SLP-CCC” Practice Location

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