Provider Demographics
NPI:1962806604
Name:DUPONT, ALEXA (MS)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1218
Mailing Address - Country:US
Mailing Address - Phone:859-802-7431
Mailing Address - Fax:
Practice Address - Street 1:71 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3006
Practice Address - Country:US
Practice Address - Phone:859-331-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPINP00211714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist