Provider Demographics
NPI:1033632898
Name:DADICH, ALEXANDRA C (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:C
Last Name:DADICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:C
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:21603 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1636
Mailing Address - Country:US
Mailing Address - Phone:248-569-5985
Mailing Address - Fax:
Practice Address - Street 1:21603 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1636
Practice Address - Country:US
Practice Address - Phone:248-569-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02103231H00000X
MI1601000791231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist