Provider Demographics
NPI:1164111894
Name:WHITEHEAD, ALEXA RENAE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:RENAE
Last Name:WHITEHEAD
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 1:3628 N DELTA HWY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1620
Mailing Address - Country:US
Mailing Address - Phone:541-852-6915
Mailing Address - Fax:
Practice Address - Street 1:3575 DONALD ST STE 260
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4744
Practice Address - Country:US
Practice Address - Phone:541-255-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14445739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist