Healthcare Provider Details

I. General information

NPI: 1609149038
Provider Name (Legal Business Name): ALEXANDRA HOAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 S CLYDE MORRIS BLVD SUITE 407
PORT ORANGE FL
32129-3004
US

IV. Provider business mailing address

8 SAINT MICHAELS TER
CARMEL NY
10512-2007
US

V. Phone/Fax

Practice location:
  • Phone: 866-450-7279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number021037-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: