Provider Demographics
NPI:1447743901
Name:CARROCCI, ALECIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:CARROCCI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2257
Mailing Address - Country:US
Mailing Address - Phone:419-681-3297
Mailing Address - Fax:
Practice Address - Street 1:250 MANOR DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3118
Practice Address - Country:US
Practice Address - Phone:419-874-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003056235Z00000X
OH09838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist