Provider Demographics
NPI:1427617778
Name:DEATHE, ALEXANDRA HOLMES (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:HOLMES
Last Name:DEATHE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4972 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-4615
Mailing Address - Country:US
Mailing Address - Phone:812-243-6113
Mailing Address - Fax:
Practice Address - Street 1:1599 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-7517
Practice Address - Country:US
Practice Address - Phone:317-914-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14230682235Z00000X
IN22007586A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist