Provider Demographics
NPI:1801199740
Name:PAGE, ALEXIS J (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:J
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:J
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:379 AZORE WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2437
Mailing Address - Country:US
Mailing Address - Phone:845-926-8311
Mailing Address - Fax:
Practice Address - Street 1:8310 RIVERS AVE STE D
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9268
Practice Address - Country:US
Practice Address - Phone:843-588-5677
Practice Address - Fax:855-632-2877
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020361-1235Z00000X
SC7845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA2674Medicaid