Provider Demographics
NPI:1124229083
Name:SIEGELMAN, STEVEN MARK (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:SIEGELMAN
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20615 N 6TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5916
Mailing Address - Country:US
Mailing Address - Phone:623-262-6830
Mailing Address - Fax:623-516-1169
Practice Address - Street 1:20615 N 6TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5916
Practice Address - Country:US
Practice Address - Phone:623-262-6830
Practice Address - Fax:623-516-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 0055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist