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General NPI Number Information
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NPI Number | 1053041012
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Entity Type | Organization
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Legal Business Name | FOXTAIL SPEECH
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 2046 PICCADILLY LN
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5503
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Country | US
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Telephone | 704-530-6180
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 PICCADILLY LN
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5503
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Country | US
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Telephone | 704-530-6180
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Fax |
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Authorized Official
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Title or Position | OWNER/ SLP
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Name | CHRISTINA F BOYLE
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Credential | MS CCC SLP
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Telephone | 704-530-6180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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