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General NPI Number Information
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NPI Number | 1790568475
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Entity Type | Individual
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Provider Name | ALEXA ELIZABETH ROUSSEL
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 12125 MAGNOLIA ST.
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City | GRAMERCY
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State | LA
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Zip | 70052
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Country | US
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Telephone | 225-331-0674
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 971
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City | GRAMERCY
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State | LA
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Zip | 70052-0971
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Country | US
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Telephone | 225-331-0674
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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 | 9429
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License Number State | LA
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