Healthcare Provider Details

I. General information

NPI: 1619799848
Provider Name (Legal Business Name): ALEXIS COLEMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 HILLSDALE LN
KISSIMMEE FL
34741
US

IV. Provider business mailing address

3227 HILLSDALE LN
KISSIMMEE FL
34741
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-2847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: