Provider Demographics
NPI:1659417608
Name:MCCORMICARE SPEECH THERAPY, INC
Entity Type:Organization
Organization Name:MCCORMICARE SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:623-974-8900
Mailing Address - Street 1:13260 N 94TH DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4828
Mailing Address - Country:US
Mailing Address - Phone:623-974-8900
Mailing Address - Fax:623-974-8911
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4828
Practice Address - Country:US
Practice Address - Phone:623-974-8900
Practice Address - Fax:623-974-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty