Healthcare Provider Details

I. General information

NPI: 1881377018
Provider Name (Legal Business Name): ALEXYS HENDERSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD
FAIRLAWN OH
44333-3770
US

IV. Provider business mailing address

2708 BLAKESLEE BLVD
MEDINA OH
44256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax:
Mailing address:
  • Phone: 330-421-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20232325-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: