Healthcare Provider Details

I. General information

NPI: 1073611174
Provider Name (Legal Business Name): EDWYNA I ALEXANDER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 OFFICE CT SUITE 305
SANTA FE NM
87507-4929
US

IV. Provider business mailing address

4001 OFFICE CT SUITE 305
SANTA FE NM
87507-4929
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-7710
  • Fax: 505-466-7714
Mailing address:
  • Phone: 505-466-7710
  • Fax: 505-466-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4288
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: