Basic Information
| Provider Information | |||||||||
| NPI: | 1164089546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 E MCDOWELL RD STE LL1 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029561250 | ||||||||
| FaxNumber: | 6233218620 | ||||||||
| Practice Location | |||||||||
| Address1: | 1492 S MILL AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852815676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808945550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA11786 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | DA11786 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.