Provider Demographics
NPI:1508554098
Name:ALEXANDER, ERIN MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:ALEXANDER
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 1:1125 BROOK ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4901
Mailing Address - Country:US
Mailing Address - Phone:802-779-1655
Mailing Address - Fax:
Practice Address - Street 1:2261 TOWN CENTER AVE STE 109
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6106
Practice Address - Country:US
Practice Address - Phone:321-255-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist