Provider Demographics
NPI:1235800640
Name:AVILA FERNANDEZ, ALEJANDRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:AVILA FERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S EGRET BAY BLVD APT 12106
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1466
Mailing Address - Country:US
Mailing Address - Phone:787-955-0635
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR AUDIOLOGY AND SPEECH PATHOLOGY
Practice Address - Street 2:301 UNIVERSITY BLVD
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77553-0523
Practice Address - Country:US
Practice Address - Phone:409-772-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist