MEDICARE: SUZETTE BERNALES SLPA

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	2355S0801X	Speech-Language Assistant	SLPA7138	AZ

General Provider Information

NPI Number	:	1518265404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZETTE BERNALES SLPA

Provider Business Mailing Address
First Line	:	44342 W YUCCA LN
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-4029
Country	:	US
Telephone Number	:	480-335-4873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2432 W PEORIA AVE
Second Line	:	SUITE 1044
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4726
Country	:	US
Telephone Number	:	480-335-4873
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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Directions to “ SUZETTE BERNALES SLPA” Practice Location

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