Provider Demographics
NPI:1164009601
Name:LARCINESE, ALEXA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:LARCINESE
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 1:5137 ROSWELL RD UNIT 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2242
Mailing Address - Country:US
Mailing Address - Phone:770-331-9442
Mailing Address - Fax:
Practice Address - Street 1:150 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3209
Practice Address - Country:US
Practice Address - Phone:770-479-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist