Healthcare Provider Details

I. General information

NPI: 1740001429
Provider Name (Legal Business Name): ALEXANDRA EAMES M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA NEUMANN M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 GOODMAN RD E STE 105
SOUTHAVEN MS
38672-8711
US

IV. Provider business mailing address

1381 HARBOR PARK DR
MEMPHIS TN
38103-9030
US

V. Phone/Fax

Practice location:
  • Phone: 662-932-4625
  • Fax:
Mailing address:
  • Phone: 314-587-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5283
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: