Provider Demographics
NPI:1063614741
Name:SPEECH CENTER OF SOUTHERN ARIZONA
Entity type:Organization
Organization Name:SPEECH CENTER OF SOUTHERN ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:520-721-4544
Mailing Address - Street 1:1860 E RIVER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5993
Mailing Address - Country:US
Mailing Address - Phone:520-721-4544
Mailing Address - Fax:
Practice Address - Street 1:1860 E RIVER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5993
Practice Address - Country:US
Practice Address - Phone:520-721-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00000174235Z00000X
AZ00135236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1386080281OtherNPI - NANCY TURMAN
1386788016OtherNPI-DIANE HANSEN
AZ144725Medicaid
AZ115742Medicaid
AZ1104114842OtherNPI - CHRISTINE BUTALLA
AZ1386080281OtherNPI - NANCY TURMAN