Provider Demographics
NPI:1114111010
Name:SARGENT, ERIN DIANE (MS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DIANE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7518
Mailing Address - Country:US
Mailing Address - Phone:480-456-0719
Mailing Address - Fax:480-456-0163
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:STE C-306
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:315-935-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist