Provider Demographics
NPI:1346609310
Name:HARKIN, ALEXANDRA PAIGE (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:PAIGE
Last Name:HARKIN
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-5203
Mailing Address - Country:US
Mailing Address - Phone:845-657-2354
Mailing Address - Fax:845-657-8504
Practice Address - Street 1:4166 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412-5203
Practice Address - Country:US
Practice Address - Phone:845-657-2354
Practice Address - Fax:845-657-8504
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY027361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05150523Medicaid