Healthcare Provider Details

I. General information

NPI: 1871004929
Provider Name (Legal Business Name): ALEXIS NOVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9444 LAPEER RD UNIT 6
DAVISON MI
48423-1755
US

IV. Provider business mailing address

PO BOX 412031
BOSTON MA
02241-2031
US

V. Phone/Fax

Practice location:
  • Phone: 810-652-8650
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: