Provider Demographics
NPI:1538301809
Name:ALEXIS, PATRICK (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 COLUMBIA ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1310
Mailing Address - Country:US
Mailing Address - Phone:917-435-4648
Mailing Address - Fax:
Practice Address - Street 1:338 COLUMBIA ST
Practice Address - Street 2:UNIT 2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1310
Practice Address - Country:US
Practice Address - Phone:917-435-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist