Provider Demographics
NPI:1285072140
Name:KRILL, ALEXANDRA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KRILL
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 1:13538 VILLAGE PARK DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7698
Mailing Address - Country:US
Mailing Address - Phone:321-872-7157
Mailing Address - Fax:
Practice Address - Street 1:13538 VILLAGE PARK DR
Practice Address - Street 2:SUITE 145
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7698
Practice Address - Country:US
Practice Address - Phone:321-872-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07200235Z00000X
FLSA13474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist