Healthcare Provider Details

I. General information

NPI: 1902732126
Provider Name (Legal Business Name): ALLISON NICOLE VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N WYATT DR
TUCSON AZ
85712-6106
US

IV. Provider business mailing address

3641 E ELIDA ST
TUCSON AZ
85716-3315
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5437
  • Fax:
Mailing address:
  • Phone: 928-920-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: