Provider Demographics
NPI:1235112848
Name:ALEXANDER, ALICIA L (CCC-A)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8123
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:1512 ARTAIUS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5231
Practice Address - Country:US
Practice Address - Phone:847-573-0073
Practice Address - Fax:847-573-8660
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80827231H00000X
IL147.001016231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80827OtherSTATE LICENSE