Provider Demographics
NPI:1831641984
Name:THEMELIS, ALEXANDRA TESIA (MS CCC-SUP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TESIA
Last Name:THEMELIS
Suffix:
Gender:F
Credentials:MS CCC-SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 N 68TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-9208
Mailing Address - Country:US
Mailing Address - Phone:425-275-6169
Mailing Address - Fax:
Practice Address - Street 1:10752 N. 89TH PLACE SUITE C128
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-247-9190
Practice Address - Fax:480-247-9718
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP60602995235Z00000X
AZSLP12486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist