Provider Demographics
NPI:1205403748
Name:MARCACCIO, ALEXA NOEL (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:NOEL
Last Name:MARCACCIO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 HARDER OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4203
Mailing Address - Country:US
Mailing Address - Phone:813-951-0924
Mailing Address - Fax:
Practice Address - Street 1:2808 HARDER OAKS AVE
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4203
Practice Address - Country:US
Practice Address - Phone:813-951-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FL19108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty