Provider Demographics
NPI:1659812626
Name:SULLIVAN, ALEXANDRA PAIGE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:PAIGE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6926
Mailing Address - Country:US
Mailing Address - Phone:202-722-5555
Mailing Address - Fax:
Practice Address - Street 1:5000 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6926
Practice Address - Country:US
Practice Address - Phone:202-722-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist