Healthcare Provider Details

I. General information

NPI: 1043125206
Provider Name (Legal Business Name): ALEXANDRA ALLEN HARRIS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOWLER DR
ATHENS GA
30601-1347
US

IV. Provider business mailing address

169 TILSON RD
ATHENS GA
30606-4516
US

V. Phone/Fax

Practice location:
  • Phone: 706-357-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14439643
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: