Provider Demographics
NPI:1487006698
Name:HEARTBEAT SPEECH THERAPY L.L.C.
Entity Type:Organization
Organization Name:HEARTBEAT SPEECH THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:YONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:480-889-4636
Mailing Address - Street 1:16454 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8559
Mailing Address - Country:US
Mailing Address - Phone:480-889-4636
Mailing Address - Fax:
Practice Address - Street 1:16454 S 29TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8559
Practice Address - Country:US
Practice Address - Phone:480-889-4636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0687251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ059586Medicaid