Provider Demographics
NPI:1336571363
Name:DVORAK, ALEXANDRA (MA)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:DVORAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PLATTE RIVER BLVD UNIT O
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4349
Mailing Address - Country:US
Mailing Address - Phone:303-659-8822
Mailing Address - Fax:303-659-7788
Practice Address - Street 1:975 PLATTE RIVER BLVD UNIT O
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4349
Practice Address - Country:US
Practice Address - Phone:303-659-8822
Practice Address - Fax:303-659-7788
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001825235Z00000X
IL146012138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSLP.0001825OtherSTATE LICENSE NUMBER
CO14055616OtherASHA ACCOUNT NUMBER
IL146012138OtherILLINOIS STATE LICENSE