Provider Demographics
NPI:1760923031
Name:SCHWABE, ALEXANDRA KATHERINE (CCC-ST)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:SCHWABE
Suffix:
Gender:F
Credentials:CCC-ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PACELLA PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1700
Mailing Address - Country:US
Mailing Address - Phone:317-584-5166
Mailing Address - Fax:317-288-3396
Practice Address - Street 1:15 PACELLA PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1700
Practice Address - Country:US
Practice Address - Phone:317-584-5166
Practice Address - Fax:317-288-3396
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14149885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist