Provider Demographics
NPI:1407111008
Name:ALEXANDER, SOPHIA (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 EL CAMINO LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2852
Mailing Address - Country:US
Mailing Address - Phone:917-601-9787
Mailing Address - Fax:
Practice Address - Street 1:153 EL CAMINO LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2852
Practice Address - Country:US
Practice Address - Phone:917-601-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0218111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist