Provider Demographics
NPI:1639839426
Name:SCOTT-JELTSCH, ALEXANDRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SCOTT-JELTSCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8339
Mailing Address - Country:US
Mailing Address - Phone:530-520-9620
Mailing Address - Fax:
Practice Address - Street 1:340 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7238
Practice Address - Country:US
Practice Address - Phone:530-332-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist