Provider Demographics
NPI:1205053485
Name:RUSIECKI, ALEXANDRA (SLP)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:RUSIECKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:GALSKOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-5023
Mailing Address - Country:US
Mailing Address - Phone:203-746-1729
Mailing Address - Fax:
Practice Address - Street 1:6 HOLLOW DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2408
Practice Address - Country:US
Practice Address - Phone:203-648-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003270235Z00000X
NJ41YS00610600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist