Provider Demographics
NPI:1053571125
Name:INGERSOLL, ALICIA MARIE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:INGERSOLL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 DURANGO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3563
Mailing Address - Country:US
Mailing Address - Phone:817-905-0578
Mailing Address - Fax:
Practice Address - Street 1:1265 DURANGO SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3563
Practice Address - Country:US
Practice Address - Phone:817-905-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist