Provider Demographics
NPI:1710581574
Name:AHMADI, ALEXIS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:AHMADI
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 1:4023 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5565
Mailing Address - Country:US
Mailing Address - Phone:949-274-6742
Mailing Address - Fax:
Practice Address - Street 1:23101 LAKE CENTER DR STE 240
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6810
Practice Address - Country:US
Practice Address - Phone:949-305-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist