Provider Demographics
NPI:1710130125
Name:PETERS, ALEXIS EVE (MS, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:EVE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ORANGE ST
Mailing Address - Street 2:APT. 1H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1723
Mailing Address - Country:US
Mailing Address - Phone:917-692-5660
Mailing Address - Fax:
Practice Address - Street 1:54 ORANGE ST
Practice Address - Street 2:APT. 1H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1723
Practice Address - Country:US
Practice Address - Phone:917-692-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist