Provider Demographics
NPI:1235900523
Name:CARR, ALEXIS A (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:CARR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:JEHNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2917 INDIAN WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2044
Mailing Address - Country:US
Mailing Address - Phone:863-633-8983
Mailing Address - Fax:
Practice Address - Street 1:2917 INDIAN WOODS TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2044
Practice Address - Country:US
Practice Address - Phone:863-633-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist