MEDICARE: MISS BEVERLY JANICE ALEXIS 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	LL00004325	WA

General Provider Information

NPI Number	:	1205042777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BEVERLY JANICE ALEXIS SLP

Provider Business Mailing Address
First Line	:	177 KINGSTON AVE
Second Line	:	APT. 4B
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2001
Country	:	US
Telephone Number	:	718-508-2142
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 KINGSTON AVE
Second Line	:	APT. 4B
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2001
Country	:	US
Telephone Number	:	718-508-2142
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/17/2007

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Directions to “ MISS BEVERLY JANICE ALEXIS SLP” Practice Location

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