Healthcare Provider Details

I. General information

NPI: 1891831509
Provider Name (Legal Business Name): PRESCOTT SPEECH & LANGUAGE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 VALLEY ST
PRESCOTT AZ
86305-1826
US

IV. Provider business mailing address

PO BOX 11312
PRESCOTT AZ
86304-1312
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-1309
  • Fax: 928-445-0914
Mailing address:
  • Phone: 928-445-1309
  • Fax: 928-445-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberOTC 4011
License Number StateAZ

VIII. Authorized Official

Name: MS. COLLEEN R POUQUETTE
Title or Position: PRESIDENT
Credential: M.S., CCC-SLP
Phone: 928-445-1309