Alexa Elyse Stubenrauch, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA18630 Issued in FL

Practice address

178 Vista Grande Dr
Ponte Vedra Beach, FL 32082-1754

Phone

(717) 875-0962

NPI assigned

May 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fame Speech and Myo

  • Speech-Language Pathologist
  • Jacksonville, FL
  • NPI 1619622859
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1154988467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 VISTA GRANDE DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821754",
            "telephone_number": "717-875-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 VISTA GRANDE DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821754",
            "telephone_number": "717-875-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBENRAUCH",
        "first_name": "ALEXA",
        "middle_name": "ELYSE",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ9286",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA18630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Neil Steiger, PA-C
• Marla Maria Steiner, MS, PTA
• Paul Christopher Steinke, PA-C
• Nina Stevens
• Carol Ann Stoops
• Successful Pathways to Wellness
• Sunny Dentistry PLLC
• Sunrise Orthodontics PLLC
• Surgery Center of Ponte Vedra Beach LLC
• Surgical Center of Ponte Vedra Beach LLC

• Speech-Language Pathologist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.