Provider Demographics
NPI:1700318169
Name:MENARD, ALEXANDRA MORGAN BRACY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MORGAN BRACY
Last Name:MENARD
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 1:1015 KLEM RD
Mailing Address - Street 2:ALEX BRACY- ROOM 113
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8618
Mailing Address - Country:US
Mailing Address - Phone:585-872-1770
Mailing Address - Fax:
Practice Address - Street 1:1015 KLEM RD
Practice Address - Street 2:ALEX BRACY- ROOM 113
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8618
Practice Address - Country:US
Practice Address - Phone:585-872-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY488576Medicaid