Healthcare Provider Details

I. General information

NPI: 1447706072
Provider Name (Legal Business Name): DIVYA DEEPAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17110 N 50TH ST
SCOTTSDALE AZ
85254-1408
US

IV. Provider business mailing address

17110 N 50TH ST
SCOTTSDALE AZ
85254-1408
US

V. Phone/Fax

Practice location:
  • Phone: 312-852-1344
  • Fax:
Mailing address:
  • Phone: 312-852-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA 10168
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP15639
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: