Provider Demographics
NPI:1053674234
Name:CONKLIN, ALEXANNE KENNEDY (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANNE
Middle Name:KENNEDY
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:8796 ROUTE 219
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824
Mailing Address - Country:US
Mailing Address - Phone:814-265-7874
Mailing Address - Fax:814-265-2082
Practice Address - Street 1:185 SOUTH MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707
Practice Address - Country:US
Practice Address - Phone:570-474-6377
Practice Address - Fax:570-474-2109
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-002762-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist