Provider Demographics
NPI:1255680690
Name:FRITZ, MARIE ELLEN (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELLEN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 S SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1071
Mailing Address - Country:US
Mailing Address - Phone:605-413-3146
Mailing Address - Fax:
Practice Address - Street 1:25555 W DURANGO ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9176
Practice Address - Country:US
Practice Address - Phone:623-925-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist