Provider Demographics
NPI:1538721634
Name:SOULE, ALEXANDRA (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:
Last Name:SOULE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 DERBY MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2722
Mailing Address - Country:US
Mailing Address - Phone:203-499-8439
Mailing Address - Fax:
Practice Address - Street 1:228 KING ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2364
Practice Address - Country:US
Practice Address - Phone:413-727-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77000235Z00000X
CT006969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006969OtherCT LICENSURE-SLP
14259865OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION