Provider Demographics
NPI:1124363262
Name:SWEET DISCOURSE LLC
Entity Type:Organization
Organization Name:SWEET DISCOURSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH-LANGUAGE PATHOLOGI
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:520-904-8406
Mailing Address - Street 1:PO BOX 90504
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-0504
Mailing Address - Country:US
Mailing Address - Phone:520-904-8406
Mailing Address - Fax:520-306-4985
Practice Address - Street 1:10590 N SHANNON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9336
Practice Address - Country:US
Practice Address - Phone:520-904-8406
Practice Address - Fax:520-306-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5523253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313557Medicaid