Provider Demographics
NPI:1639292634
Name:TUCSON SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:TUCSON SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:LAZELL
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, COM
Authorized Official - Phone:520-298-7883
Mailing Address - Street 1:1200 N EL DORADO PL STE A-150
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4637
Mailing Address - Country:US
Mailing Address - Phone:520-298-7883
Mailing Address - Fax:520-298-0035
Practice Address - Street 1:1200 N EL DORADO PL STE A-150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-298-7883
Practice Address - Fax:520-298-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ735459Medicaid
AZAZ0144070OtherBLUE CROSS BLUE SHIELD ID