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NPI Code Detail

MEDICARE: NK SPEECH THERAPY AND BEHAVIOR SUPPORT PLLC

MEDICARE: NK SPEECH THERAPY AND BEHAVIOR SUPPORT PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant
2103K00000XBehavior Analyst
3106S00000XBehavior Technician
4225100000XPhysical Therapist
5225200000XPhysical Therapy Assistant
6225X00000XOccupational Therapist
72355S0801XSpeech-Language Assistant
8235Z00000XSpeech-Language Pathologist
9261QH0700XHearing and Speech Clinic/Center

General Provider Information

NPI Number : 1104561471
Entity Type Code : Organization
Provider Name (Legal Business Name) : NK SPEECH THERAPY AND BEHAVIOR SUPPORT PLLC
Provider Business Mailing Address
First Line : 5783 S FAWN AVE
Second Line :
City : GILBERT
State : AZ
Zip : 85298-0848
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7776 S POINTE PKWY W STE 250
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-5428
Country : US
Telephone Number : 480-518-7073
Fax Number :
Authorized Official
Title or Position : OWNER
Name : NICOLE KAVANAGH
Credential : CCC-SLP
Telephone Number : 480-518-7073
Provider Enumeration Date : 05/02/2022
Last Update Date : 10/12/2022

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