MEDICARE: MS. RANDY LYNN DASHEFSKY MS CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP0443	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLP0443	OTHER	AZ	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1205953189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RANDY LYNN DASHEFSKY MS CCC-SLP

Provider Business Mailing Address
First Line	:	8007 E WINDWOOD LN
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6440
Country	:	US
Telephone Number	:	480-474-4068
Fax Number	:	480-474-4069

Provider Business Practice Location Address
First Line	:	14421 N. 23RD AVE.
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-6099
Country	:	US
Telephone Number	:	602-896-5700
Fax Number	:	602-896-5720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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