Provider Demographics
NPI:1851834436
Name:TANNER, ALEXANDRA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:M
Last Name:TANNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4433
Mailing Address - Country:US
Mailing Address - Phone:212-860-5868
Mailing Address - Fax:212-860-6077
Practice Address - Street 1:535 E 119TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4433
Practice Address - Country:US
Practice Address - Phone:212-860-5868
Practice Address - Fax:212-860-6077
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024129-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist