Provider Demographics
NPI:1922436609
Name:WEILAND, ALEXIS TERESITA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:TERESITA
Last Name:WEILAND
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 1:12836 OLD GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7041
Mailing Address - Country:US
Mailing Address - Phone:907-717-5193
Mailing Address - Fax:
Practice Address - Street 1:12836 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7041
Practice Address - Country:US
Practice Address - Phone:907-717-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist