Provider Demographics
NPI:1447442405
Name:ALEXANDER, KEISA LYZETTE (MA)
Entity type:Individual
Prefix:
First Name:KEISA
Middle Name:LYZETTE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 BODENGER BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6004
Mailing Address - Country:US
Mailing Address - Phone:504-939-9894
Mailing Address - Fax:
Practice Address - Street 1:1512 BODENGER BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6004
Practice Address - Country:US
Practice Address - Phone:504-939-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist