Provider Demographics
NPI:1073611174
Name:ALEXANDER, EDWYNA I (SLP)
Entity Type:Individual
Prefix:
First Name:EDWYNA
Middle Name:I
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OFFICE CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4929
Mailing Address - Country:US
Mailing Address - Phone:505-466-7710
Mailing Address - Fax:505-466-7714
Practice Address - Street 1:4001 OFFICE CT
Practice Address - Street 2:SUITE 305
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4929
Practice Address - Country:US
Practice Address - Phone:505-466-7710
Practice Address - Fax:505-466-7714
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4288OtherNEW MEXICO REGULATING & LICENSING DEPARTMENT
TX16424OtherSTATE BOARD
TX89044TOtherBCBS