Provider Demographics
NPI:1427350081
Name:FLORY, RUSSELL (SLPA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:FLORY
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 W MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3753
Mailing Address - Country:US
Mailing Address - Phone:623-551-7424
Mailing Address - Fax:
Practice Address - Street 1:3730 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3753
Practice Address - Country:US
Practice Address - Phone:623-551-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA7029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist