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General NPI Number Information
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NPI Number | 1447681499
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Entity Type | Individual
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Provider Name | ALEXANDRA ALLEN M.A., CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 105 W A ST
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City | BELLEVILLE
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State | IL
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Zip | 62220-1326
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Country | US
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Telephone | 618-233-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 2723 N 39TH ST
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City | FAIRMONT CITY
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State | IL
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Zip | 62201-2155
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Country | US
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Telephone | 618-803-1910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.011641
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License Number State | IL
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