Healthcare Provider Details

I. General information

NPI: 1225945264
Provider Name (Legal Business Name): ALEXIS JACQUES SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 15TH ST
SANTA MONICA CA
90404-1802
US

IV. Provider business mailing address

1340 15TH ST
SANTA MONICA CA
90404-1802
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-9706
  • Fax: 310-451-0369
Mailing address:
  • Phone: 858-204-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: