Provider Demographics
NPI:1154726792
Name:HIGGINBOTHAM, RONALD (SLP-A)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N SIBYL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-6115
Mailing Address - Country:US
Mailing Address - Phone:520-720-9790
Mailing Address - Fax:
Practice Address - Street 1:433 N SIBYL RD
Practice Address - Street 2:
Practice Address - City:SAINT DAVID
Practice Address - State:AZ
Practice Address - Zip Code:85630-6115
Practice Address - Country:US
Practice Address - Phone:520-720-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA78962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant