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NPI Code Detail

MEDICARE: MRS. ALEXANDRA ALLEN M.A., CCC-SLP/L

MEDICARE: MRS. ALEXANDRA ALLEN M.A., CCC-SLP/L
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
1235Z00000XSpeech-Language Pathologist146.011641IL

General Provider Information

NPI Number : 1447681499
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALEXANDRA ALLEN M.A., CCC-SLP/L
Provider Business Mailing Address
First Line : 2723 N 39TH ST
Second Line :
City : FAIRMONT CITY
State : IL
Zip : 62201-2155
Country : US
Telephone Number : 618-803-1910
Fax Number :
Provider Business Practice Location Address
First Line : 105 W A ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1326
Country : US
Telephone Number : 618-233-2830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2013
Last Update Date : 12/02/2013

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Directions to “ MRS. ALEXANDRA ALLEN M.A., CCC-SLP/L” Practice Location

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