Provider Demographics
NPI:1861249591
Name:SPANGLER, ALEXIS MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MARIE
Other - Last Name:ERB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1327 NEW BERLIN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17855-8014
Mailing Address - Country:US
Mailing Address - Phone:570-713-4811
Mailing Address - Fax:
Practice Address - Street 1:1327 NEW BERLIN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17855-8014
Practice Address - Country:US
Practice Address - Phone:570-713-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty