Provider Demographics
NPI:1619424447
Name:ALEXANDER, BLAKE JENNIFER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:JENNIFER
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 1:3301 ROBIN TRL
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-0336
Mailing Address - Country:US
Mailing Address - Phone:985-688-4489
Mailing Address - Fax:
Practice Address - Street 1:3301 ROBIN TRL
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-0336
Practice Address - Country:US
Practice Address - Phone:985-688-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist