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General NPI Number Information
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NPI Number | 1356698625
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Entity Type | Organization
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Legal Business Name | LADYBUG SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE SUITE #140
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 623-643-8616
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Fax | 623-362-2218
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Provider Business Mailing Address
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Address Line | 20325 N 51ST AVE SUITE #140
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 623-643-8616
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Fax | 623-362-2218
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST/OWNER
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Name | MS. MONICA DEANN GALLEGOS
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Credential | M.S., CCC-SLP
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Telephone | 623-643-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4470
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License Number State | AZ
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