Healthcare Provider Details

I. General information

NPI: 1306240817
Provider Name (Legal Business Name): THERAPY TREE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20329 N 59TH AVE STE A2
GLENDALE AZ
85308-6854
US

IV. Provider business mailing address

20329 N 59TH AVE STE A2
GLENDALE AZ
85308-6854
US

V. Phone/Fax

Practice location:
  • Phone: 623-500-2401
  • Fax: 623-209-8822
Mailing address:
  • Phone: 602-384-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSLP7933
License Number StateAZ

VIII. Authorized Official

Name: EMILIE WILLIS
Title or Position: CEO
Credential: M.H.S. CCC-SLP
Phone: 602-384-0815