Provider Demographics
NPI:1023410800
Name:ROSS, ALEXANDRA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:217 W CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6549
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:
Practice Address - Street 1:2700 N MAIN ST STE 945
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6678
Practice Address - Country:US
Practice Address - Phone:714-542-1234
Practice Address - Fax:714-542-1002
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5170235Z00000X
CA22770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist