Provider Demographics
NPI:1023350600
Name:LI, ZEXIN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ZEXIN
Middle Name:
Last Name:LI
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 1:2820 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1344
Mailing Address - Country:US
Mailing Address - Phone:785-760-7335
Mailing Address - Fax:
Practice Address - Street 1:4255 GALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5479
Practice Address - Country:US
Practice Address - Phone:719-425-7771
Practice Address - Fax:303-223-0084
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14047081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist