Provider Demographics
NPI:1437396181
Name:ALEXANDER, CONSTANCE GREY (MA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:GREY
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2525
Mailing Address - Country:US
Mailing Address - Phone:607-748-0562
Mailing Address - Fax:
Practice Address - Street 1:505 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2525
Practice Address - Country:US
Practice Address - Phone:607-761-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000382-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist