Provider Demographics
NPI:1922554336
Name:BAIR, ALEXANDRA FRY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:FRY
Last Name:BAIR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:LYNN
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1565 N TIMBERCREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5883
Mailing Address - Country:US
Mailing Address - Phone:717-440-8329
Mailing Address - Fax:
Practice Address - Street 1:363 MCKNIGHT AVENUE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-0419
Practice Address - Country:US
Practice Address - Phone:479-839-3035
Practice Address - Fax:479-839-3037
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013090235Z00000X
AR200706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist