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General NPI Number Information
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NPI Number | 1154587590
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Entity Type | Organization
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Legal Business Name | ADHEARENCE, LLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 6425 W CONSTANCE WAY
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City | LAVEEN
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State | AZ
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Zip | 85339-2798
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Country | US
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Telephone | 602-705-8705
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Fax | 602-323-2241
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Provider Business Mailing Address
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Address Line | 6425 W CONSTANCE WAY
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City | LAVEEN
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State | AZ
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Zip | 85339-2798
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Country | US
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Telephone | 602-705-8705
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Fax | 602-323-2241
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | SUSAN EILEEN VAN WIE
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Credential | M.S., SLP-L, CCC/A
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Telephone | 602-705-8705
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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 | SLPL4532
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD5402
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License Number State | AZ
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