Basic Information
| Provider Information | |||||||||
| NPI: | 1174110324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVOA | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4609 BARNHILL LN | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761352533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179627302 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2104 GREENBRIAR DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760928355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174429022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2020 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 117550 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.