Provider Demographics
NPI:1316455132
Name:LAFUENTE ESQUIVEL, ANDREA (SLPA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LAFUENTE ESQUIVEL
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 1:14435 S 48TH ST APT 2122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6450
Mailing Address - Country:US
Mailing Address - Phone:225-454-0305
Mailing Address - Fax:
Practice Address - Street 1:3712 E LATHAM CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-3017
Practice Address - Country:US
Practice Address - Phone:225-454-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA109362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty