Provider Demographics
NPI:1811433972
Name:WOOD, ALEXIS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WOOD
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:UNIT 7130 BOX 1118
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09709-1118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 7130 BOX 1118
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:09709-1118
Practice Address - Country:US
Practice Address - Phone:703-955-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist