Provider Demographics
NPI:1902280241
Name:PADILLA, ANISSA (BA)
Entity type:Individual
Prefix:MISS
First Name:ANISSA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 N BRIGADIER DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-6707
Mailing Address - Country:US
Mailing Address - Phone:480-987-5360
Mailing Address - Fax:
Practice Address - Street 1:29697 N DESERT WILLOW BLVD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-3917
Practice Address - Country:US
Practice Address - Phone:480-987-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA94122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant