Provider Demographics
NPI:1982463394
Name:POPE, ALEXIS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:POPE
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 1:599 BUSHY HEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY LOG
Mailing Address - State:GA
Mailing Address - Zip Code:30522-2029
Mailing Address - Country:US
Mailing Address - Phone:770-905-5190
Mailing Address - Fax:
Practice Address - Street 1:941 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5599
Practice Address - Country:US
Practice Address - Phone:443-414-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1797516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist