Provider Demographics
NPI:1093003824
Name:MARCUS, ALEXANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-538-3700
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:180 MAIN RD
Practice Address - Street 2:
Practice Address - City:BROWNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04414-3107
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007464235Z00000X
WALL60442277235Z00000X
MA8545235Z00000X
MESP3501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist