Provider Demographics
NPI:1386307874
Name:LEXIS PEDIATRIC SPEECH THERAPY
Entity type:Organization
Organization Name:LEXIS PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRYSTALA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOLAOU
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:951-237-6088
Mailing Address - Street 1:842 JANSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2438
Mailing Address - Country:US
Mailing Address - Phone:951-237-6088
Mailing Address - Fax:
Practice Address - Street 1:842 JANSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2438
Practice Address - Country:US
Practice Address - Phone:951-237-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech