Provider Demographics
NPI:1528898301
Name:HEREDIA, AYLIN ALEXIS
Entity type:Individual
Prefix:
First Name:AYLIN
Middle Name:ALEXIS
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W LAKE PARK RD APT 806
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3886
Mailing Address - Country:US
Mailing Address - Phone:620-214-0837
Mailing Address - Fax:
Practice Address - Street 1:4612 DAVID STRICKLAND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5299
Practice Address - Country:US
Practice Address - Phone:620-214-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX433602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant