Healthcare Provider Details

I. General information

NPI: 1457871105
Provider Name (Legal Business Name): ALEXANDRA MICHELLE MCNICHOLAS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E CHESTNUT AVE # 714
SANTA ANA CA
92701-6322
US

IV. Provider business mailing address

84 TIERRA PLANO
RANCHO SANTA MARGARITA CA
92688-3342
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-5501
  • Fax:
Mailing address:
  • Phone: 949-573-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: