Provider Demographics
NPI:1548856925
Name:ALEXANDER, JULIA ANN-LOUISE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN-LOUISE
Last Name:ALEXANDER
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 1:1517 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-4507
Mailing Address - Country:US
Mailing Address - Phone:903-746-8790
Mailing Address - Fax:
Practice Address - Street 1:212 OLD GRANDE BLVD STE A110
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4256
Practice Address - Country:US
Practice Address - Phone:903-509-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist