Provider Demographics
NPI:1235384728
Name:ALEXANDER, WENDY L (MED, CCC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MED, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8149
Mailing Address - Country:US
Mailing Address - Phone:770-645-5566
Mailing Address - Fax:
Practice Address - Street 1:3725 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE B3
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2320
Practice Address - Country:US
Practice Address - Phone:770-831-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA657846811AMedicaid