Provider Demographics
NPI:1285323196
Name:AZ HOMESCHOOL SLP LLC
Entity type:Organization
Organization Name:AZ HOMESCHOOL SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:520-850-1025
Mailing Address - Street 1:8307 E STATE RTE 69
Mailing Address - Street 2:STE 1 #25803
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312
Mailing Address - Country:US
Mailing Address - Phone:520-850-1025
Mailing Address - Fax:928-877-8125
Practice Address - Street 1:3948 N TAYLOR DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8227
Practice Address - Country:US
Practice Address - Phone:520-850-1025
Practice Address - Fax:928-877-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech