MEDICARE: MASON ALLEN PEARSON

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	SLPA13991	AZ

General Provider Information

NPI Number	:	1710612072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON ALLEN PEARSON

Provider Business Mailing Address
First Line	:	4201 W UNION HILLS DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1749
Country	:	US
Telephone Number	:	623-698-6840
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 W UNION HILLS DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1749
Country	:	US
Telephone Number	:	623-698-6840
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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Directions to “ MASON ALLEN PEARSON ” Practice Location

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