Provider Demographics
NPI:1285912287
Name:BARKLAGE, ALIECE NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALIECE
Middle Name:NICOLE
Last Name:BARKLAGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WYNDING GATE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-385-4414
Mailing Address - Fax:
Practice Address - Street 1:2002 BOARDWALK PLACE DR
Practice Address - Street 2:
Practice Address - City:OFALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2308
Practice Address - Country:US
Practice Address - Phone:636-625-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311679605Medicare UPIN