Provider Demographics
NPI:1861103558
Name:CONWELL, ALEXANDRA GRACE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GRACE
Last Name:CONWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MED PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6310
Mailing Address - Country:US
Mailing Address - Phone:931-538-3755
Mailing Address - Fax:931-538-3756
Practice Address - Street 1:235 MED PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6310
Practice Address - Country:US
Practice Address - Phone:931-538-3755
Practice Address - Fax:931-538-3756
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist