Provider Demographics
NPI:1831709195
Name:HUSTEDT-MAI, ALEXANDRA (AUD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HUSTEDT-MAI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD STE 221
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:630-386-2174
Mailing Address - Fax:
Practice Address - Street 1:885 KEMPSVILLE RD STE 221
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-226-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001785231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist