Provider Demographics
NPI:1881338812
Name:REAGAN, ALEXA SARAVI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:SARAVI
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:ROYA
Other - Last Name:SARAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:1762 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7406
Mailing Address - Country:US
Mailing Address - Phone:850-204-8030
Mailing Address - Fax:
Practice Address - Street 1:1762 SEA LARK LN
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7406
Practice Address - Country:US
Practice Address - Phone:850-204-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010378235Z00000X
FLSA20191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA20191OtherFLORIDA SPEECH-LANGUAGE LICENSE
VA2202010378OtherVIRGINIA SPEECH-LANGUAGE LICENSE
VA2204000711OtherVIRGINIA PROVISIONAL SPEECH-LANGUAGE LICENSE
14293950OtherASHA CCC-SLP