Provider Demographics
NPI:1629383005
Name:SPEECH AMERICA LEARNING ASSOCIATE, INC.
Entity Type:Organization
Organization Name:SPEECH AMERICA LEARNING ASSOCIATE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PICCININNI
Authorized Official - Suffix:
Authorized Official - Credentials:MA,
Authorized Official - Phone:480-375-5054
Mailing Address - Street 1:21001 N TATUM BLVD
Mailing Address - Street 2:STE 1630-126
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:480-375-5054
Mailing Address - Fax:480-368-7956
Practice Address - Street 1:6050 N INVERGORDON RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5248
Practice Address - Country:US
Practice Address - Phone:480-375-5054
Practice Address - Fax:480-874-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty