Individual
ALEXA RAE AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
49 STATE RD, WATUPPA BUILDING, SUITE 105, NORTH DARTMOUTH, MA 02747-0274
(508) 985-1996
(508) 985-0067
Mailing address
3 CHESTER AVE, BERKLEY, MA 02779-2318
(774) 218-0669
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
77937-SP-SL
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14406277
AMERICAN SPEECH LANGUAGE HEARING ASSOCIATIONS (ASHA)
—
01
—
77937-SP-SL
MA LICENSING
MA
Enumeration date
03/05/2021
Last updated
03/05/2021
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