Healthcare Provider Details

I. General information

NPI: 1336415520
Provider Name (Legal Business Name): ALEXANDRA G CAYIAS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MARIA GEORGOPOULOS M.S. CFY-SLP

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E G50
MURRAY UT
84107-8100
US

IV. Provider business mailing address

127 S 500 E 600
SALT LAKE CITY UT
84102-1959
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-5000
  • Fax:
Mailing address:
  • Phone: 801-587-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8005589-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: