Individual
ALEXANDRA GLOFF VANNATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
719 JEWELL DR, WACO, TX 76712-6624
(254) 870-1752
Mailing address
575 W 4TH ST, CRAWFORD, TX 76638-3218
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
84568
TX
235Z00000X
Speech-Language Pathologist
37048
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39048
STATE BOARD OF EXAMINERS FOR SPEECH PATHOLOGY
TX
Enumeration date
06/21/2017
Last updated
05/23/2022
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