Healthcare Provider Details

I. General information

NPI: 1750449898
Provider Name (Legal Business Name): ALEXANDRA GANTNER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 E FAIRFIELD ST
MESA AZ
85213-5342
US

IV. Provider business mailing address

10424 N 42ND PL
PHOENIX AZ
85028-4146
US

V. Phone/Fax

Practice location:
  • Phone: 402-321-0406
  • Fax:
Mailing address:
  • Phone: 773-339-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: