Provider Demographics
NPI:1548094626
Name:LIRA, MIGUEL DE JESUS (SLPA)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:DE JESUS
Last Name:LIRA
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 1:70 S VAL VISTA DR # A3-311
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1374
Mailing Address - Country:US
Mailing Address - Phone:480-294-8871
Mailing Address - Fax:480-608-2728
Practice Address - Street 1:70 S VAL VISTA DR # A3-311
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1374
Practice Address - Country:US
Practice Address - Phone:480-294-8871
Practice Address - Fax:480-608-2728
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA150592355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant