Healthcare Provider Details

I. General information

NPI: 1295456796
Provider Name (Legal Business Name): AWAKEN YOUR VOICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E WESCOTT DR
PHOENIX AZ
85050-2572
US

IV. Provider business mailing address

2510 E WESCOTT DR
PHOENIX AZ
85050-2572
US

V. Phone/Fax

Practice location:
  • Phone: 602-702-9257
  • Fax: 602-636-1887
Mailing address:
  • Phone: 602-702-9257
  • Fax: 602-636-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLA G LOVE
Title or Position: SPEECH-LANGUAGE PATHOLOGY ASSISTANT
Credential: SLPA
Phone: 602-702-9257