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General NPI Number Information
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NPI Number | 1518119577
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Entity Type | Organization
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Legal Business Name | SURPRISE SPEECH THERAPY
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 15315 W PERSHING ST
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City | SURPRISE
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State | AZ
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Zip | 85379-8159
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Country | US
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Telephone | 623-521-0571
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Fax |
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Provider Business Mailing Address
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Address Line | 15315 W PERSHING ST
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City | SURPRISE
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State | AZ
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Zip | 85379-8159
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Country | US
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Telephone | 623-521-0571
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MAI LING CHAN
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Credential | MS, CCC-SLP
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Telephone | 623-521-0571
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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 | SLP5051
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License Number State | AZ
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