Provider Demographics
NPI:1679086912
Name:HEBERER, ALEXANDRA (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HEBERER
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4210 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4864
Mailing Address - Country:US
Mailing Address - Phone:563-676-1202
Mailing Address - Fax:
Practice Address - Street 1:4130 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4243
Practice Address - Country:US
Practice Address - Phone:563-391-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist