Provider Demographics
NPI:1811461080
Name:SIMEUR, ALEXANDRA KATHERINE (SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:SIMEUR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W BARRY AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6304
Mailing Address - Country:US
Mailing Address - Phone:630-621-5254
Mailing Address - Fax:
Practice Address - Street 1:1221 E GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1213
Practice Address - Country:US
Practice Address - Phone:847-768-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist