Healthcare Provider Details

I. General information

NPI: 1841612686
Provider Name (Legal Business Name): ALEXANDRA ALTENBURG CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA ADAMS

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 REID DAIRY RD
WAXHAW NC
28173-8532
US

IV. Provider business mailing address

6129 PROVIDENCE GLEN RD
CHARLOTTE NC
28270-3739
US

V. Phone/Fax

Practice location:
  • Phone: 540-550-2542
  • Fax:
Mailing address:
  • Phone: 540-550-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13905
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: