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General NPI Number Information
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NPI Number | 1740604719
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MOBILE MBS, LLC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 712 E MICHIGAN AVE
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City | PHOENIX
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State | AZ
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Zip | 85022-1194
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Country | US
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Telephone | 480-375-0145
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Fax | 602-535-4702
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Provider Business Mailing Address
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Address Line | 712 E MICHIGAN AVE
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City | PHOENIX
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State | AZ
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Zip | 85022-1194
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Country | US
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Telephone | 480-375-0145
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Fax | 602-535-4702
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | NOELLE M NICOLAS
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Credential | SLP
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Telephone | 480-375-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP5512
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License Number State | AZ
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