Provider Demographics
NPI:1518265404
Name:BERNALES, SUZETTE (SLPA)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:BERNALES
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:DE LEON-BERNALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:44342 W YUCCA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4029
Mailing Address - Country:US
Mailing Address - Phone:480-335-4873
Mailing Address - Fax:
Practice Address - Street 1:2432 W PEORIA AVE
Practice Address - Street 2:SUITE 1044
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4726
Practice Address - Country:US
Practice Address - Phone:480-335-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA71382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant