Provider Demographics
NPI:1073166088
Name:GAGAS, ALEXANDRA (SLP- 235Z00000X)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GAGAS
Suffix:
Gender:F
Credentials:SLP- 235Z00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 CHESTNUT PL APT 541
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6050
Mailing Address - Country:US
Mailing Address - Phone:203-906-2446
Mailing Address - Fax:
Practice Address - Street 1:1801 CHESTNUT PL APT 541
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6050
Practice Address - Country:US
Practice Address - Phone:203-906-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO242801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist