Provider Demographics
NPI:1205042777
Name:ALEXIS, BEVERLY JANICE (SLP)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:JANICE
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 KINGSTON AVE
Mailing Address - Street 2:APT. 4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2001
Mailing Address - Country:US
Mailing Address - Phone:718-508-2142
Mailing Address - Fax:
Practice Address - Street 1:177 KINGSTON AVE
Practice Address - Street 2:APT. 4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2001
Practice Address - Country:US
Practice Address - Phone:718-508-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist