Provider Demographics
NPI:1033288808
Name:TERRY, NADIA (SLP, MAED)
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:SLP, MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 91ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:623-722-2340
Mailing Address - Fax:623-877-1028
Practice Address - Street 1:3802 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2368
Practice Address - Country:US
Practice Address - Phone:623-722-2340
Practice Address - Fax:623-877-1028
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ889404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ550774Medicaid