Healthcare Provider Details

I. General information

NPI: 1821524612
Provider Name (Legal Business Name): MARIA BAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E BROADWAY AVE
APACHE JUNCTION AZ
85119-9301
US

IV. Provider business mailing address

1515 S EXTENSION RD APT. 3139
MESA AZ
85210-4973
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA10408
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: