Provider Demographics
NPI:1194193797
Name:SHARON HENDRICKSON PFEIL, M.S., CCC, LLC
Entity Type:Organization
Organization Name:SHARON HENDRICKSON PFEIL, M.S., CCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDRICKSON-PFEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:520-241-6943
Mailing Address - Street 1:PO BOX 40162
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85717-0162
Mailing Address - Country:US
Mailing Address - Phone:520-241-6943
Mailing Address - Fax:520-325-8259
Practice Address - Street 1:1601 N TUCSON BLVD
Practice Address - Street 2:STE. 5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3425
Practice Address - Country:US
Practice Address - Phone:520-241-6943
Practice Address - Fax:520-325-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1027261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
00501486OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION, CCC-SLP
AZSLP1027OtherSPEECH PATHOLOGY LICENSE