Healthcare Provider Details

I. General information

NPI: 1336190115
Provider Name (Legal Business Name): SOUTHWEST CENTER FOR COMMUNICATION DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 AINSWORTH DR SUITE C
PRESCOTT AZ
86301-1630
US

IV. Provider business mailing address

802 AINSWORTH DR SUITE C
PRESCOTT AZ
86301-1630
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-0172
  • Fax: 928-777-0174
Mailing address:
  • Phone: 928-777-0172
  • Fax: 928-777-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3469
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0732
License Number StateAZ

VIII. Authorized Official

Name: MS. LISA CRUJIDO
Title or Position: OWNER/ADMINISTRATOR
Credential: M.S. CCC-SLP
Phone: 928-777-0172