Provider Demographics
NPI:1558728956
Name:PROGRESSIVE SPEECH LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPEECH LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASADY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:623-340-4104
Mailing Address - Street 1:5125 N 40TH ST APT F126
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-9132
Mailing Address - Country:US
Mailing Address - Phone:623-340-4104
Mailing Address - Fax:
Practice Address - Street 1:5125 N 40TH ST APT F126
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-9132
Practice Address - Country:US
Practice Address - Phone:623-340-4104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty