Provider Demographics
NPI:1568776169
Name:MACIAS-HARRIS, JUDITH MARGARET (BSLP-CFY)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARGARET
Last Name:MACIAS-HARRIS
Suffix:
Gender:F
Credentials:BSLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 N BURBANK CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4321
Mailing Address - Country:US
Mailing Address - Phone:602-999-7998
Mailing Address - Fax:
Practice Address - Street 1:1709 N BURBANK CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4321
Practice Address - Country:US
Practice Address - Phone:602-999-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTSLP 6880OtherARIZONA DEPARTMENT OF HEALTH