Healthcare Provider Details

I. General information

NPI: 1154587590
Provider Name (Legal Business Name): ADHEARENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 W CONSTANCE WAY
LAVEEN AZ
85339-2798
US

IV. Provider business mailing address

6425 W CONSTANCE WAY
LAVEEN AZ
85339-2798
US

V. Phone/Fax

Practice location:
  • Phone: 602-705-8705
  • Fax: 602-323-2241
Mailing address:
  • Phone: 602-705-8705
  • Fax: 602-323-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD5402
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPL4532
License Number StateAZ

VIII. Authorized Official

Name: SUSAN EILEEN VAN WIE
Title or Position: AUDIOLOGIST
Credential: M.S., SLP-L, CCC/A
Phone: 602-705-8705