Healthcare Provider Details

I. General information

NPI: 1194487967
Provider Name (Legal Business Name): ARIZONA SPEECH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 W CETON DR
LAVEEN AZ
85339-7702
US

IV. Provider business mailing address

4327 W CETON DR
LAVEEN AZ
85339-7702
US

V. Phone/Fax

Practice location:
  • Phone: 602-635-6017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN DELANO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-622-2810