Provider Demographics
NPI:1033875901
Name:SUPERIOR SPEECH AND LANGUAGE SERVICES, LLC
Entity Type:Organization
Organization Name:SUPERIOR SPEECH AND LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:GIBBONS
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:928-243-5137
Mailing Address - Street 1:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-2011
Mailing Address - Country:US
Mailing Address - Phone:928-243-5137
Mailing Address - Fax:
Practice Address - Street 1:240 N 9TH W
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-4562
Practice Address - Country:US
Practice Address - Phone:928-243-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1518196682Medicaid