Provider Demographics
NPI:1336842061
Name:CICCONE, ALEXIS GRACE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GRACE
Last Name:CICCONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAVENDER BLOOM LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8703
Mailing Address - Country:US
Mailing Address - Phone:610-500-0809
Mailing Address - Fax:
Practice Address - Street 1:7820 BALTUSROL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3270
Practice Address - Country:US
Practice Address - Phone:703-468-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist