Provider Demographics
NPI:1689830861
Name:HEISER, ALEXIS A (SLP, CCC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:HEISER
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11765 W COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-9450
Mailing Address - Country:US
Mailing Address - Phone:419-435-0019
Mailing Address - Fax:
Practice Address - Street 1:541 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2572
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 9126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist