Provider Demographics
NPI:1063823516
Name:CARRILLO, ALEXANDRA B (MA-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:B
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8657 W 95TH DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5322
Mailing Address - Country:US
Mailing Address - Phone:303-444-2248
Mailing Address - Fax:
Practice Address - Street 1:2501 KITTREDGE LOOP RD 409 UCB
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-2420
Practice Address - Country:US
Practice Address - Phone:303-492-5375
Practice Address - Fax:303-492-6560
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist