MEDICARE: ALEXANDRA GIBSON

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		NY

General Provider Information

NPI Number	:	1043642275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GIBSON

Provider Business Mailing Address
First Line	:	2924 S GRANT ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 S GRANT ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2331
Country	:	US
Telephone Number	:	703-405-5366
Fax Number	:

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

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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Directions to “ ALEXANDRA GIBSON ” Practice Location

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