Provider Demographics
NPI:1760676985
Name:SEGOVICH, ALEXIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:SEGOVICH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:PRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:17603 ALTA CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4698
Mailing Address - Country:US
Mailing Address - Phone:815-834-1253
Mailing Address - Fax:
Practice Address - Street 1:17603 ALTA CT
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-4698
Practice Address - Country:US
Practice Address - Phone:815-834-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist