Provider Demographics
NPI:1578189718
Name:REGALADO, ALICE ALEXANDRA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ALEXANDRA
Last Name:REGALADO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 STONELAKE DR APT 512
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8786
Mailing Address - Country:US
Mailing Address - Phone:956-648-9434
Mailing Address - Fax:
Practice Address - Street 1:2701 AIRPORT FWY STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2378
Practice Address - Country:US
Practice Address - Phone:682-564-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist