Healthcare Provider Details

I. General information

NPI: 1972288504
Provider Name (Legal Business Name): SMILES THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 E BUTTONBUSH CT
TUCSON AZ
85748-7871
US

IV. Provider business mailing address

10110 E BUTTONBUSH CT
TUCSON AZ
85748-7871
US

V. Phone/Fax

Practice location:
  • Phone: 528-243-0933
  • Fax:
Mailing address:
  • Phone: 520-243-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LEADE
Title or Position: OWNER/ SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 520-243-0933