Provider Demographics
NPI:1871821223
Name:EAST, ALICIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:EAST
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NAKINA
Mailing Address - State:NC
Mailing Address - Zip Code:28455-0220
Mailing Address - Country:US
Mailing Address - Phone:910-641-4151
Mailing Address - Fax:910-641-4152
Practice Address - Street 1:3450 JAMES B WHITE HWY S
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8678
Practice Address - Country:US
Practice Address - Phone:910-641-4151
Practice Address - Fax:910-641-4152
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist