Provider Demographics
NPI:1093160053
Name:WELBORN, ALEXANDRIA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:
Last Name:WELBORN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:71964-9449
Mailing Address - Country:US
Mailing Address - Phone:501-760-7759
Mailing Address - Fax:501-463-5411
Practice Address - Street 1:205 WOLF ST
Practice Address - Street 2:
Practice Address - City:PEARCY
Practice Address - State:AR
Practice Address - Zip Code:71964-9449
Practice Address - Country:US
Practice Address - Phone:501-760-7759
Practice Address - Fax:501-463-5411
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184100721Medicaid