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General NPI Number Information
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NPI Number | 1639918592
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE KOTOWSKI MS-CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1565 MAIN ST STE 1B
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City | TEWKSBURY
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State | MA
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Zip | 01876-4735
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Country | US
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Telephone | 978-257-1564
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Fax | 978-488-4011
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Provider Business Mailing Address
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Address Line | 1565 MAIN STREET, SUIT 1B
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City | TEWKSBURY
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State | MA
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Zip | 01876
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Country | US
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Telephone | 978-257-1564
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Fax | 978-488-4011
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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 | SLP100401
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License Number State | MA
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