Provider Demographics
NPI:1376770032
Name:LOTT, ALEXIS SAULL (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:SAULL
Last Name:LOTT
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 1:6123 LINTON ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6745
Mailing Address - Country:US
Mailing Address - Phone:561-758-5168
Mailing Address - Fax:
Practice Address - Street 1:6123 LINTON ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6745
Practice Address - Country:US
Practice Address - Phone:561-758-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8655235Z00000X
HISP1012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist