Provider Demographics
NPI:1568861177
Name:DESERT THERAPY GROUP PLLC
Entity Type:Organization
Organization Name:DESERT THERAPY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYMER-JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-827-9117
Mailing Address - Street 1:4254 E DEER DANCER WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:899 N WILMOT RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1714
Practice Address - Country:US
Practice Address - Phone:520-820-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1415SLP235Z00000X
AZSLP1245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty