Provider Demographics
NPI:1437505567
Name:CALLAHAN, TIMOTHY (SLPA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 N 44TH ST
Mailing Address - Street 2:APT 3099
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3200
Mailing Address - Country:US
Mailing Address - Phone:623-363-0703
Mailing Address - Fax:
Practice Address - Street 1:2252 N 44TH ST
Practice Address - Street 2:APT 3099
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3200
Practice Address - Country:US
Practice Address - Phone:623-363-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA99282355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant