MEDICARE: SPEECH PATHOLOGY AND CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	SLP4761	AZ

General Provider Information

NPI Number	:	1700104502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH PATHOLOGY AND CONSULTING

Provider Business Mailing Address
First Line	:	7006 S FOREST AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-9171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7006 S FOREST AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-9171
Country	:	US
Telephone Number	:	760-717-4843
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/SPEECH-LANGUAGE PATHOLOGIS
Name	:	LORI TAYLOR
Credential	:	SLP
Telephone Number	:	760-717-4843

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/04/2010

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Directions to “SPEECH PATHOLOGY AND CONSULTING ” Practice Location

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