Provider Demographics
NPI:1285046094
Name:ALEXANDER, LATIFAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LATIFAH
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 10340
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0340
Mailing Address - Country:US
Mailing Address - Phone:254-699-3933
Mailing Address - Fax:
Practice Address - Street 1:181 W BUSINESS 190
Practice Address - Street 2:SUITE # 7
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3671
Practice Address - Country:US
Practice Address - Phone:254-699-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX446409YS6Medicaid