Healthcare Provider Details

I. General information

NPI: 1073669388
Provider Name (Legal Business Name): ALAINE JOYCE GERVAIS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

IV. Provider business mailing address

13844 ELIOT AVE
ORLANDO FL
32827-7543
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 407-361-5429
  • Fax: 321-281-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: