Provider Demographics
NPI:1194456921
Name:HEREDIA, ALEJANDRA IRENE
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:IRENE
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 E FORT LOWELL RD UNIT 6223
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2485
Mailing Address - Country:US
Mailing Address - Phone:520-470-9803
Mailing Address - Fax:
Practice Address - Street 1:2002 E FORT LOWELL RD UNIT 6223
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2485
Practice Address - Country:US
Practice Address - Phone:520-470-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
AZSLPA137982355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant