Provider Demographics
NPI:1639903248
Name:RUSSO, ALEXANDRA ELIZABETH (SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:RUSSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1096
Mailing Address - Country:US
Mailing Address - Phone:860-305-6442
Mailing Address - Fax:
Practice Address - Street 1:108 CATHERINE DR
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1096
Practice Address - Country:US
Practice Address - Phone:860-305-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist