Provider Demographics
NPI:1447398706
Name:ARELLANO, ALICIA (MS CFY-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CFY-SLP
Mailing Address - Street 1:6671 W MEGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1673
Mailing Address - Country:US
Mailing Address - Phone:480-753-3908
Mailing Address - Fax:
Practice Address - Street 1:9401 W GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1606
Practice Address - Country:US
Practice Address - Phone:623-907-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ775306Medicaid