Provider Demographics
NPI:1164039616
Name:ALEXANDRA GALLAGHER MS CCC-SLP LLC
Entity Type:Organization
Organization Name:ALEXANDRA GALLAGHER MS CCC-SLP LLC
Other - Org Name:ALEXANDRA GALLAGHER SLP
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:484-301-0154
Mailing Address - Street 1:1326 N MASCHER ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4630
Mailing Address - Country:US
Mailing Address - Phone:484-301-0154
Mailing Address - Fax:888-368-9574
Practice Address - Street 1:1326 N MASCHER ST UNIT E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-4630
Practice Address - Country:US
Practice Address - Phone:772-359-6469
Practice Address - Fax:833-227-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL012837OtherLICENSE