Provider Demographics
NPI:1053923565
Name:ALEXANDER, CAROLINE RUTH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:RUTH
Last Name:ALEXANDER
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 1:2750 E BELTLINE AVE NE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-8614
Mailing Address - Country:US
Mailing Address - Phone:616-447-5880
Mailing Address - Fax:616-391-6238
Practice Address - Street 1:2750 E BELTLINE AVE NE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-8614
Practice Address - Country:US
Practice Address - Phone:616-447-5880
Practice Address - Fax:616-391-6238
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14273235Z00000X
MI7101007441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE AVAILABLE; MEDICAID APPLICATION IN PROCESS