Provider Demographics
NPI:1003535964
Name:VERTUCCI, ALEXZANDREA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXZANDREA
Middle Name:
Last Name:VERTUCCI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WYLIE EAST DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5701
Mailing Address - Country:US
Mailing Address - Phone:972-429-3150
Mailing Address - Fax:
Practice Address - Street 1:3000 WYLIE EAST DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5701
Practice Address - Country:US
Practice Address - Phone:972-429-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist