Provider Demographics
NPI:1053205567
Name:HANNIGAN, AVERY RYAN (SLPA)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:RYAN
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E PLAYA DEL NORTE DR UNIT 1219
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-2179
Mailing Address - Country:US
Mailing Address - Phone:559-770-7236
Mailing Address - Fax:
Practice Address - Street 1:3406 W MALDONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6318
Practice Address - Country:US
Practice Address - Phone:480-913-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA162792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant