Provider Demographics
NPI:1356110449
Name:PURDY, ALEXANDRA CHASE (CF-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHASE
Last Name:PURDY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:CHACE
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:1662 GLEN AYLSA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2138
Mailing Address - Country:US
Mailing Address - Phone:607-592-9123
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST STE 5100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5331
Practice Address - Country:US
Practice Address - Phone:800-872-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20010235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist