Provider Demographics
NPI:1831434554
Name:TREVISO, ALIXANDRA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALIXANDRA
Middle Name:
Last Name:TREVISO
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 1:101 SUMMER ST
Mailing Address - Street 2:UNIT 912
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2322
Mailing Address - Country:US
Mailing Address - Phone:860-573-2109
Mailing Address - Fax:
Practice Address - Street 1:698 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3302
Practice Address - Country:US
Practice Address - Phone:203-852-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist