Provider Demographics
NPI:1093160053
Name:WEATHERFORD, ALEXANDRIA MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:ALEXANDRIA
Other - Middle Name:MARIE
Other - Last Name:WELBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:205 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:71964-9449
Mailing Address - Country:US
Mailing Address - Phone:501-767-2306
Mailing Address - Fax:501-760-6550
Practice Address - Street 1:205 WOLF ST
Practice Address - Street 2:
Practice Address - City:PEARCY
Practice Address - State:AR
Practice Address - Zip Code:71964-9449
Practice Address - Country:US
Practice Address - Phone:501-767-7909
Practice Address - Fax:501-760-6550
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184100721Medicaid