Provider Demographics
NPI:1164865515
Name:ALDRICH, CHARLES ALBERT IV
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALBERT
Last Name:ALDRICH
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 E CAMELBACK RD
Mailing Address - Street 2:STE D300
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2432
Mailing Address - Country:US
Mailing Address - Phone:623-349-1373
Mailing Address - Fax:
Practice Address - Street 1:6991 E CAMELBACK RD
Practice Address - Street 2:STE D300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2432
Practice Address - Country:US
Practice Address - Phone:623-349-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA8230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist