MEDICARE: ALEXANDRA GALLAGHER MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00711200	NJ
2	235Z00000X	Speech-Language Pathologist	SL012837	PA

General Provider Information

NPI Number	:	1033525886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GALLAGHER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1326 N MASCHER ST UNIT E
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4630
Country	:	US
Telephone Number	:	484-301-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 N MASCHER ST UNIT E
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4630
Country	:	US
Telephone Number	:	484-301-0154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	03/25/2021

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