Provider Demographics
NPI:1962913210
Name:SPECK, PATTI SUE (M ED CCC SLP)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:SUE
Last Name:SPECK
Suffix:
Gender:F
Credentials:M ED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5857
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:WILSON K-8 SCHOOL
Practice Address - Street 2:2330 W. GLOVER RD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742
Practice Address - Country:US
Practice Address - Phone:520-696-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist