MEDICARE: ALEJANDRA IRENE HEREDIA

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	2355S0801X	Speech-Language Assistant
2	2355S0801X	Speech-Language Assistant	SLPA13798	AZ

General Provider Information

NPI Number	:	1194456921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRA IRENE HEREDIA

Provider Business Mailing Address
First Line	:	2002 E FORT LOWELL RD UNIT 6223
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2485
Country	:	US
Telephone Number	:	520-470-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 E FORT LOWELL RD UNIT 6223
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2485
Country	:	US
Telephone Number	:	520-470-9803
Fax Number	:

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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Directions to “ ALEJANDRA IRENE HEREDIA ” Practice Location

Language	Start Address	Practice Location

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