Provider Demographics
NPI:1548870793
Name:STAUDENMEIER, ALEXIS NOEL (AUD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOEL
Last Name:STAUDENMEIER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRAPE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1455
Mailing Address - Country:US
Mailing Address - Phone:240-446-4337
Mailing Address - Fax:
Practice Address - Street 1:205 N BROAD ST STE 401
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1553
Practice Address - Country:US
Practice Address - Phone:215-762-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006711231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist