Provider Demographics
NPI:1205365822
Name:KORNEGAY, ALIX NICOLE (AUD)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:NICOLE
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALIX
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:11439 SPRING CYPRESS RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-6513
Mailing Address - Country:US
Mailing Address - Phone:936-273-4437
Mailing Address - Fax:936-273-3279
Practice Address - Street 1:17350 ST LUKES WAY STE 115
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4103
Practice Address - Country:US
Practice Address - Phone:936-273-4437
Practice Address - Fax:936-273-3279
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80858231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist