Provider Demographics
NPI:1033894365
Name:HENNELLY, ALEXANDRA EILEEN (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:EILEEN
Last Name:HENNELLY
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:LEXIE
Other - Middle Name:
Other - Last Name:HENNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1025 N NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4510
Mailing Address - Country:US
Mailing Address - Phone:757-705-0786
Mailing Address - Fax:
Practice Address - Street 1:6231 LEESBURG PIKE STE 520
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-685-1070
Practice Address - Fax:703-685-0151
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist