Provider Demographics
NPI:1356494421
Name:GURUPRASAD, ARCHANA (MS, CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ARCHANA
Middle Name:
Last Name:GURUPRASAD
Suffix:
Gender:F
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 1:1600 W 12TH ST
Mailing Address - Street 2:APPT 1121
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3694
Mailing Address - Country:US
Mailing Address - Phone:928-783-4331
Mailing Address - Fax:928-783-4331
Practice Address - Street 1:1600 W 12TH ST
Practice Address - Street 2:APPT 1121
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3694
Practice Address - Country:US
Practice Address - Phone:928-783-4331
Practice Address - Fax:928-783-4331
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5216235Z00000X
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist