MEDICARE: ALEXA CHRISTINE VAN HAUTE 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	789	NE

General Provider Information

NPI Number	:	1720694920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA CHRISTINE VAN HAUTE SLP

Provider Business Mailing Address
First Line	:	2008 LIBERTY LN
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68133-2373
Country	:	US
Telephone Number	:	402-707-5837
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 LIBERTY LN
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68133-2373
Country	:	US
Telephone Number	:	402-707-5837
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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Directions to “ ALEXA CHRISTINE VAN HAUTE SLP” Practice Location

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