Provider Demographics
NPI:1639918592
Name:KOTOWSKI, ALEXANDRA MARIE (MS-CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:KOTOWSKI
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 1:1565 MAIN STREET, SUIT 1B
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876
Mailing Address - Country:US
Mailing Address - Phone:978-257-1564
Mailing Address - Fax:978-488-4011
Practice Address - Street 1:1565 MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4735
Practice Address - Country:US
Practice Address - Phone:978-257-1564
Practice Address - Fax:978-488-4011
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASLP100401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist