Provider Demographics
NPI:1770115123
Name:ST CROIX, ALEXIS BROOKE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BROOKE
Last Name:ST CROIX
Suffix:
Gender:F
Credentials: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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-0097
Mailing Address - Country:US
Mailing Address - Phone:802-760-7850
Mailing Address - Fax:
Practice Address - Street 1:420 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461-8924
Practice Address - Country:US
Practice Address - Phone:802-760-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0131181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist