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General NPI Number Information
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NPI Number | 1225424559
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Entity Type | Organization
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Legal Business Name | SEQUOIA EDKEY
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 1460 S HORNE
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City | MESA
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State | AZ
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Zip | 85204-5760
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Country | US
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Telephone | 480-641-3206
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 S HORNE
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City | MESA
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State | AZ
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Zip | 85204-5760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SLPA
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Name | CAITLIN MCCONNELL
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Credential |
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Telephone | 480-461-3206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA7312
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License Number State | AZ
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