Provider Demographics
NPI:1578098414
Name:CROSS, ALEXIS BROOKE (MS CCC - SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:BROOKE
Last Name:CROSS
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 1:12521 DEERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2337
Mailing Address - Country:US
Mailing Address - Phone:813-263-5400
Mailing Address - Fax:
Practice Address - Street 1:12521 DEERBERRY LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2337
Practice Address - Country:US
Practice Address - Phone:813-263-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist