Provider Demographics
NPI:1356834329
Name:KISH, ALEXIS HALEY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:HALEY
Last Name:KISH
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 1:101 CHARLES ST APT 1FW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6123
Mailing Address - Country:US
Mailing Address - Phone:215-783-4886
Mailing Address - Fax:
Practice Address - Street 1:353 W 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5094
Practice Address - Country:US
Practice Address - Phone:212-929-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist