Provider Demographics
NPI:1710722269
Name:TOBIN, ALEXANDRIA LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LYNN
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MARCELINE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8264
Mailing Address - Country:US
Mailing Address - Phone:989-640-4328
Mailing Address - Fax:
Practice Address - Street 1:1505 MARCELINE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-8264
Practice Address - Country:US
Practice Address - Phone:989-640-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14258870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist