MEDICARE: SPEAKOLOGY, LLC

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	SLP7550	AZ

General Provider Information

NPI Number	:	1922580414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAKOLOGY, LLC

Provider Business Mailing Address
First Line	:	3462 E LIBERTY LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-7362
Country	:	US
Telephone Number	:	480-748-8167
Fax Number	:

Provider Business Practice Location Address
First Line	:	3462 E LIBERTY LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-7362
Country	:	US
Telephone Number	:	480-748-8167
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JORDAN RIORDAN
Credential	:
Telephone Number	:	480-748-8167

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	08/31/2018

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Directions to “SPEAKOLOGY, LLC ” Practice Location

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