Provider Demographics
NPI:1053041012
Name:FOXTAIL SPEECH
Entity Type:Organization
Organization Name:FOXTAIL SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SLP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:704-530-6180
Mailing Address - Street 1:2046 PICCADILLY LN
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5503
Mailing Address - Country:US
Mailing Address - Phone:704-530-6180
Mailing Address - Fax:
Practice Address - Street 1:2046 PICCADILLY LN
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5503
Practice Address - Country:US
Practice Address - Phone:704-530-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty