Provider Demographics
NPI:1356554497
Name:FREEMAN, ALENA A (MCLSC)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MCLSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 JOHN K HALL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2855
Mailing Address - Country:US
Mailing Address - Phone:704-544-7547
Mailing Address - Fax:
Practice Address - Street 1:11905 JOHN K HALL WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2855
Practice Address - Country:US
Practice Address - Phone:704-544-7547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6282231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist