Healthcare Provider Details

I. General information

NPI: 1538071733
Provider Name (Legal Business Name): ALEXA DEEANN LYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W UNIVERSITY AVE STE 104
FLAGSTAFF AZ
86001-3154
US

IV. Provider business mailing address

1651 N GEMINI DR APT 59
FLAGSTAFF AZ
86001-1611
US

V. Phone/Fax

Practice location:
  • Phone: 928-228-5463
  • Fax:
Mailing address:
  • Phone: 360-399-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: