Provider Demographics
NPI:1841437571
Name:ALEXANDER, LORISSA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORISSA
Middle Name:
Last Name:ALEXANDER
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 1:6030 SOUTHARD TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6343
Mailing Address - Country:US
Mailing Address - Phone:770-886-6204
Mailing Address - Fax:678-261-6421
Practice Address - Street 1:6030 SOUTHARD TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6343
Practice Address - Country:US
Practice Address - Phone:770-886-6204
Practice Address - Fax:678-261-6421
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist