Provider Demographics
NPI:1417594292
Name:ALEXANDER, ELIANNE (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIANNE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-01 BROADWAY STE 12
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6018
Mailing Address - Country:US
Mailing Address - Phone:201-355-5199
Mailing Address - Fax:
Practice Address - Street 1:15-01 BROADWAY STE 12
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6018
Practice Address - Country:US
Practice Address - Phone:201-355-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00799300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist