Individual
MISS ALEXANDRA NALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
636 MANTON ST, PHILADELPHIA, PA 19147-4829
(267) 481-2501
Mailing address
636 MANTON ST, PHILADELPHIA, PA 19147-4829
(267) 481-2501
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL014214
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14196124
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION LICENSE
—
Enumeration date
02/04/2019
Last updated
06/24/2019
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