Healthcare Provider Details

I. General information

NPI: 1558853473
Provider Name (Legal Business Name): BRITTANY TALAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY BELL

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 W. MCDOWELL ROAD
GOODYEAR AZ
85395
US

IV. Provider business mailing address

21951 W ANTELOPE TRL
BUCKEYE AZ
85326-7874
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 814-758-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA10174
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: