Provider Demographics
NPI:1568036499
Name:MAKIYAMA, ALEXANDER KOJI
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KOJI
Last Name:MAKIYAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 E BELLERIVE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7026
Mailing Address - Country:US
Mailing Address - Phone:602-580-8117
Mailing Address - Fax:
Practice Address - Street 1:4904 E BELLERIVE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7026
Practice Address - Country:US
Practice Address - Phone:602-580-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA129172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty