Provider Demographics
NPI:1780122580
Name:KLEEBERGER, ALEXIS SHEID (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:SHEID
Last Name:KLEEBERGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:DANIELLE
Other - Last Name:SHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:333 SMITH AVE N
Mailing Address - Street 2:ATTN: SPEECH THERAPY DEPARTMENT
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2344
Mailing Address - Country:US
Mailing Address - Phone:651-241-8038
Mailing Address - Fax:
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:ATTN: SPEECH THERAPY DEPARTMENT
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9744235Z00000X
MD07198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist