Provider Demographics
NPI:1255210456
Name:CARDENAS, ALEXIS BLAKE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:BLAKE
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:BLAKE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2740 RYAN PLACE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3125
Mailing Address - Country:US
Mailing Address - Phone:817-996-4538
Mailing Address - Fax:
Practice Address - Street 1:4400 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3189
Practice Address - Country:US
Practice Address - Phone:219-879-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22009338A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist