Healthcare Provider Details

I. General information

NPI: 1023249323
Provider Name (Legal Business Name): ARIZONA SPEECH PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 E SOUTHERN AVE STE 7
TEMPE AZ
85282-7628
US

IV. Provider business mailing address

2435 E SOUTHERN AVE STE 7
TEMPE AZ
85282-7628
US

V. Phone/Fax

Practice location:
  • Phone: 480-451-7226
  • Fax:
Mailing address:
  • Phone: 480-451-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberE2106133
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberE2106133
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. TRISH J NEDBERG
Title or Position: OWNER
Credential: MS CCC SLP
Phone: 480-451-7226